Provider Demographics
NPI:1346662780
Name:TOOTHMAN DENTAL GROUP LLC
Entity Type:Organization
Organization Name:TOOTHMAN DENTAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BARTH
Authorized Official - Middle Name:MATT
Authorized Official - Last Name:TOOTHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:614-457-4585
Mailing Address - Street 1:1920 BETHEL RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-1802
Mailing Address - Country:US
Mailing Address - Phone:614-457-4585
Mailing Address - Fax:614-457-6047
Practice Address - Street 1:1920 BETHEL RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-1802
Practice Address - Country:US
Practice Address - Phone:614-457-4585
Practice Address - Fax:614-457-6047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-18
Last Update Date:2014-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH16866122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty