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General NPI Number Information
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NPI Number | 1720214976
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Entity Type | Organization
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Legal Business Name | TOOTH FAIRIES LLC
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Dates
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Enumeration Date | 06/02/2009
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Last Update Date | 06/02/2009
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Provider Practice Location Address
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Address Line | 146 CORMORANT DR
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City | STEILACOOM
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State | WA
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Zip | 98388-1720
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Country | US
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Telephone | 253-905-1692
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Fax |
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Provider Business Mailing Address
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Address Line | 146 CORMORANT DR
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City | STEILACOOM
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State | WA
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Zip | 98388-1720
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Country | US
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Telephone | 253-905-1692
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | NANCY C ALLEMAN
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Credential | RDH BS
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Telephone | 253-905-1682
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | DH00001654
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License Number State | WA
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