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General NPI Number Information
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NPI Number | 1821755018
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Entity Type | Organization
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Legal Business Name | BEND TOOTHFAIRIES
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Dates
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Enumeration Date | 11/22/2021
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Last Update Date | 11/22/2021
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Provider Practice Location Address
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Address Line | 61394 COACHMAN WAY
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City | BEND
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State | OR
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Zip | 97702-3840
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Country | US
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Telephone | 541-515-7228
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Fax |
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Provider Business Mailing Address
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Address Line | 61394 COACHMAN WAY
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City | BEND
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State | OR
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Zip | 97702-3840
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TRYSTA BUEHRIG
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Credential | RDH, EPDH
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Telephone | 541-515-7228
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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 |
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License Number State |
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