Provider Demographics
NPI:1437616547
Name:SWEET TOOTH PEDIATRIC DENTISTRY & ORTHODONTIC SPECIALISTS LLC
Entity Type:Organization
Organization Name:SWEET TOOTH PEDIATRIC DENTISTRY & ORTHODONTIC SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOBBINS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:480-343-5072
Mailing Address - Street 1:7381 W 133RD ST STE 303
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-4779
Mailing Address - Country:US
Mailing Address - Phone:208-220-3785
Mailing Address - Fax:
Practice Address - Street 1:7381 W 133RD ST STE 303
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-4779
Practice Address - Country:US
Practice Address - Phone:480-343-5072
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-25
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty