Provider Demographics
NPI:1790492312
Name:TINY TEETH PEDIATRIC DENTISTRY PLLC
Entity Type:Organization
Organization Name:TINY TEETH PEDIATRIC DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:PINA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:860-583-8469
Mailing Address - Street 1:710 KING ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-4477
Mailing Address - Country:US
Mailing Address - Phone:860-583-8469
Mailing Address - Fax:860-583-8470
Practice Address - Street 1:710 KING ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-4477
Practice Address - Country:US
Practice Address - Phone:860-583-8469
Practice Address - Fax:860-583-8470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty