Provider Demographics
NPI:1376111997
Name:TOOTH TOWN DENTISTRY 4 KIDS
Entity Type:Organization
Organization Name:TOOTH TOWN DENTISTRY 4 KIDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NATALY
Authorized Official - Middle Name:
Authorized Official - Last Name:PENUELAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-680-0186
Mailing Address - Street 1:13471 N TRAILING INDIGO CT
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85755-6040
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15990 S RANCHO SAHUARITA BLVD STE 110
Practice Address - Street 2:
Practice Address - City:SAHUARITA
Practice Address - State:AZ
Practice Address - Zip Code:85629-8022
Practice Address - Country:US
Practice Address - Phone:520-363-4774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-11
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty