Provider Demographics
NPI:1861012569
Name:SMALL, TONI-MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:TONI-MARIE
Middle Name:
Last Name:SMALL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 IRONWORKS AVE APT 288
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46544-2071
Mailing Address - Country:US
Mailing Address - Phone:561-808-5489
Mailing Address - Fax:
Practice Address - Street 1:12625 76TH RD N
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33412-2259
Practice Address - Country:US
Practice Address - Phone:561-808-5489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-22
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12013434A1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry