MEDICARE: TEETHWISE DENTAL PC

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

General Provider Information

NPI Number	:	1518556885
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEETHWISE DENTAL PC

Provider Business Mailing Address
First Line	:	3809 ATASCOCITA RD STE 700
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77396-4628
Country	:	US
Telephone Number	:	281-446-0225
Fax Number	:

Provider Business Practice Location Address
First Line	:	3809 ATASCOCITA RD STE 700
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77396-4628
Country	:	US
Telephone Number	:	281-446-0225
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. OMOWUMI LADIPO
Credential	:	DDS
Telephone Number	:	281-446-0225

Provider Enumeration Date	:	01/12/2021
Last Update Date	:	01/12/2021

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Directions to “TEETHWISE DENTAL PC ” Practice Location

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