Provider Demographics
NPI:1114204302
Name:THE TOOTH FAIRY, INC.
Entity Type:Organization
Organization Name:THE TOOTH FAIRY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:V
Authorized Official - Last Name:SCHLOEDER
Authorized Official - Suffix:
Authorized Official - Credentials:RDH, LAP
Authorized Official - Phone:503-843-3348
Mailing Address - Street 1:21300 GOOSENECK CR. RD.
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:OR
Mailing Address - Zip Code:97378-9543
Mailing Address - Country:US
Mailing Address - Phone:503-843-3348
Mailing Address - Fax:503-843-3348
Practice Address - Street 1:21300 GOOSENECK CREEK RD
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:OR
Practice Address - Zip Code:97378-9573
Practice Address - Country:US
Practice Address - Phone:503-843-3348
Practice Address - Fax:503-843-3348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH-3797124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty