Provider Demographics
NPI:1003217043
Name:DR. TORIE'S DENTAL SHOPPE, PC
Entity Type:Organization
Organization Name:DR. TORIE'S DENTAL SHOPPE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR./OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VIKTORIA
Authorized Official - Middle Name:ALLISON
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:219-805-9159
Mailing Address - Street 1:130 E JOLIET ST
Mailing Address - Street 2:
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-2013
Mailing Address - Country:US
Mailing Address - Phone:219-322-4036
Mailing Address - Fax:
Practice Address - Street 1:130 E JOLIET ST
Practice Address - Street 2:
Practice Address - City:SCHERERVILLE
Practice Address - State:IN
Practice Address - Zip Code:46375-2013
Practice Address - Country:US
Practice Address - Phone:219-322-4036
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-09
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011172A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty