Provider Demographics
NPI:1275094864
Name:ITOOTH FAMILY DENTISTRY, LLC
Entity Type:Organization
Organization Name:ITOOTH FAMILY DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:SPENCER
Authorized Official - Last Name:ROBBINS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:417-883-8515
Mailing Address - Street 1:3211 E BATTLEFIELD ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-4071
Mailing Address - Country:US
Mailing Address - Phone:417-883-8515
Mailing Address - Fax:888-975-3724
Practice Address - Street 1:3211 E BATTLEFIELD ST STE 100
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-4071
Practice Address - Country:US
Practice Address - Phone:417-883-8515
Practice Address - Fax:888-975-3724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-27
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental