Provider Demographics
NPI:1073221339
Name:TOOTH BUD PEDIATRIC DENTISTRY
Entity Type:Organization
Organization Name:TOOTH BUD PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:YASMINA
Authorized Official - Middle Name:D
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:215-850-2761
Mailing Address - Street 1:7835 BUIST AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19153-1204
Mailing Address - Country:US
Mailing Address - Phone:215-850-2761
Mailing Address - Fax:
Practice Address - Street 1:21 W HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19118-3309
Practice Address - Country:US
Practice Address - Phone:215-792-7999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103799750-0008Medicaid