Provider Demographics
NPI:1821755018
Name:BEND TOOTHFAIRIES
Entity Type:Organization
Organization Name:BEND TOOTHFAIRIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRYSTA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUEHRIG
Authorized Official - Suffix:
Authorized Official - Credentials:RDH, EPDH
Authorized Official - Phone:541-515-7228
Mailing Address - Street 1:61394 COACHMAN WAY
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-3840
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:61394 COACHMAN WAY
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3840
Practice Address - Country:US
Practice Address - Phone:541-515-7228
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-22
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty