Provider Demographics
NPI:1235643016
Name:TOOTH DOCTOR - CH, LLC
Entity Type:Organization
Organization Name:TOOTH DOCTOR - CH, LLC
Other - Org Name:THE TOOTH DOCTOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEVIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:ORVIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-989-7803
Mailing Address - Street 1:2180 E FORT UNION BLVD
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD HEIGHTS
Mailing Address - State:UT
Mailing Address - Zip Code:84121-3148
Mailing Address - Country:US
Mailing Address - Phone:801-944-4141
Mailing Address - Fax:
Practice Address - Street 1:2180 E FORT UNION BLVD
Practice Address - Street 2:
Practice Address - City:COTTONWOOD HEIGHTS
Practice Address - State:UT
Practice Address - Zip Code:84121-3148
Practice Address - Country:US
Practice Address - Phone:801-944-4141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TD OPERATIONS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-11-30
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8813690-9922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty