Provider Demographics
NPI:1427576990
Name:TOOTH IN BOOTS PEDIATRIC DENTISTRY, LLC
Entity Type:Organization
Organization Name:TOOTH IN BOOTS PEDIATRIC DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:RUGAMA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:562-235-9110
Mailing Address - Street 1:22377 BELLAIRE BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-3926
Mailing Address - Country:US
Mailing Address - Phone:832-280-7545
Mailing Address - Fax:832-827-8494
Practice Address - Street 1:22377 BELLAIRE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-3926
Practice Address - Country:US
Practice Address - Phone:832-280-7545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-06
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX317131223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty