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General NPI Number Information
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NPI Number | 1841925526
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Entity Type | Organization
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Legal Business Name | TOOTHASAURUS CHILDRENS DENTISRTY
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Dates
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Enumeration Date | 07/18/2022
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Last Update Date | 08/17/2023
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Provider Practice Location Address
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Address Line | 5256 VILLAGE MARKET
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City | WESLEY CHAPEL
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State | FL
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Zip | 33544-8400
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Country | US
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Telephone | 813-907-3100
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Fax | 813-907-3110
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Provider Business Mailing Address
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Address Line | 5256 VILLAGE MARKET
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City | WESLEY CHAPEL
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State | FL
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Zip | 33544-8400
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Country | US
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Telephone | 813-907-3100
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. TIERNEY PETTINATO
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Credential | DMD
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Telephone | 813-778-3140
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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