Provider Demographics
NPI:1073955878
Name:TOOTHFAIRY NYC ORAL & MAXILLOFACIAL SURGERY PC
Entity Type:Organization
Organization Name:TOOTHFAIRY NYC ORAL & MAXILLOFACIAL SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:SASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-331-9278
Mailing Address - Street 1:437 W 125TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-4201
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:437 W 125TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-4201
Practice Address - Country:US
Practice Address - Phone:212-280-1635
Practice Address - Fax:646-837-0510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-22
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty