Provider Demographics
NPI:1093469827
Name:TOOTH FAIRY DENTAL II LLC
Entity Type:Organization
Organization Name:TOOTH FAIRY DENTAL II LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:DOCTOR
Authorized Official - Phone:561-891-9046
Mailing Address - Street 1:10205 S DIXIE HWY STE 200-201
Mailing Address - Street 2:
Mailing Address - City:PINECREST
Mailing Address - State:FL
Mailing Address - Zip Code:33156-3167
Mailing Address - Country:US
Mailing Address - Phone:561-891-9046
Mailing Address - Fax:
Practice Address - Street 1:10205 S DIXIE HWY STE 200-201
Practice Address - Street 2:
Practice Address - City:PINECREST
Practice Address - State:FL
Practice Address - Zip Code:33156-3167
Practice Address - Country:US
Practice Address - Phone:561-891-9046
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-10
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental