Provider Demographics
NPI:1548381775
Name:TOOTHACRES DENTAL INC.
Entity Type:Organization
Organization Name:TOOTHACRES DENTAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAD
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:HELM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:208-773-8388
Mailing Address - Street 1:105 E 10TH AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-5125
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:208-777-0346
Practice Address - Street 1:105 E 10TH AVE
Practice Address - Street 2:SUITE B
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-5125
Practice Address - Country:US
Practice Address - Phone:208-773-8388
Practice Address - Fax:208-777-0346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-38661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty