Provider Demographics
NPI:1265815054
Name:TOOTH TALES
Entity Type:Organization
Organization Name:TOOTH TALES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:P
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-236-5273
Mailing Address - Street 1:12741 MIRAMAR PKWY
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-2903
Mailing Address - Country:US
Mailing Address - Phone:954-236-5273
Mailing Address - Fax:954-653-2967
Practice Address - Street 1:12741 MIRAMAR PARKWAY
Practice Address - Street 2:SUITE 203
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027
Practice Address - Country:US
Practice Address - Phone:954-236-5273
Practice Address - Fax:954-653-2967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-30
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN166821223P0221X
FLDN914441223P0221X
FLDN159431223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty