Provider Demographics
NPI:1518556885
Name:TEETHWISE DENTAL PC
Entity Type:Organization
Organization Name:TEETHWISE DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OMOWUMI
Authorized Official - Middle Name:
Authorized Official - Last Name:LADIPO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-446-0225
Mailing Address - Street 1:3809 ATASCOCITA RD STE 700
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77396-4628
Mailing Address - Country:US
Mailing Address - Phone:281-446-0225
Mailing Address - Fax:
Practice Address - Street 1:3809 ATASCOCITA RD STE 700
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77396-4628
Practice Address - Country:US
Practice Address - Phone:281-446-0225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental