Provider Demographics
NPI:1720214976
Name:TOOTH FAIRIES LLC
Entity Type:Organization
Organization Name:TOOTH FAIRIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:C
Authorized Official - Last Name:ALLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RDH BS
Authorized Official - Phone:253-905-1682
Mailing Address - Street 1:146 CORMORANT DR
Mailing Address - Street 2:
Mailing Address - City:STEILACOOM
Mailing Address - State:WA
Mailing Address - Zip Code:98388-1720
Mailing Address - Country:US
Mailing Address - Phone:253-905-1692
Mailing Address - Fax:
Practice Address - Street 1:146 CORMORANT DR
Practice Address - Street 2:
Practice Address - City:STEILACOOM
Practice Address - State:WA
Practice Address - Zip Code:98388-1720
Practice Address - Country:US
Practice Address - Phone:253-905-1692
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-02
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADH00001654124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5902002Medicaid