Provider Demographics
NPI:1013199611
Name:TICKLE TOOTH DENTAL
Entity Type:Organization
Organization Name:TICKLE TOOTH DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HANDEL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:610-636-8872
Mailing Address - Street 1:235 S POTTSTOWN PIKE
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2747
Mailing Address - Country:US
Mailing Address - Phone:610-363-8872
Mailing Address - Fax:610-363-8212
Practice Address - Street 1:235 S POTTSTOWN PIKE
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2747
Practice Address - Country:US
Practice Address - Phone:610-363-8872
Practice Address - Fax:610-363-8212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS025722122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty