MEDICARE: TOOTH FAIRY DENTAL I LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487308201
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOOTH FAIRY DENTAL I LLC

Provider Business Mailing Address
First Line	:	15495 EAGLE NEST LN STE 110
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33014-2242
Country	:	US
Telephone Number	:	561-891-9046
Fax Number	:

Provider Business Practice Location Address
First Line	:	15495 EAGLE NEST LN STE 110
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33014-2242
Country	:	US
Telephone Number	:	561-891-9046
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SCOTT SPENCER
Credential	:	DOCTOR
Telephone Number	:	561-891-9046

Provider Enumeration Date	:	02/10/2022
Last Update Date	:	02/10/2022

Similar Medicare Providers

1588558423 — ACCESS MEDICAL GROUP OF MIAMI MEDICARE, LLC
Practice Location Address:

701 NW 27TH AVE
MIAMI, FL
33125-3012

Practice Phone: 786-744-1900
Practice Fax: 305-760-4141

1427002591 — TENDER LOVING CARE HEALTH CARE SERVICES OF DADE, LLC
Practice Location Address:

15495 EAGLE NEST LN , STE 260
MIAMI LAKES, FL
33014-2242

Practice Phone: 305-365-2050
Practice Fax: 305-822-9415

1154608370 — LITTLE SMILES DENTAL OFFICE #1
Practice Location Address:

15495 EAGLE NEST LN STE 110
MIAMI LAKES, FL
33014-2242

Practice Phone: 305-698-7566
Practice Fax: 305-698-7565

1558993501 — PROMED IMAGING, LLC
Practice Location Address:

15495 EAGLE NEST LN STE 130
MIAMI LAKES, FL
33014-2242

Practice Phone: 305-901-7199
Practice Fax:

1881220747 — UNIFIED MEDICAL LLC
Practice Location Address:

15495 EAGLE NEST LN STE 130
MIAMI LAKES, FL
33014-2242

Practice Phone: 305-330-5510
Practice Fax:

1568906196 — YAIMA SOUTUYO
Practice Location Address:

10090 NW 80TH CT APT 1427
MIAMI LAKES, FL
33016-2242

Practice Phone: 786-286-8483
Practice Fax:

Directions to “TOOTH FAIRY DENTAL I LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.