Provider Demographics
NPI:1275389066
Name:TOOTH PLYMOUTH PLLC
Entity Type:Organization
Organization Name:TOOTH PLYMOUTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:MEGAN
Authorized Official - Last Name:DANYAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-707-5025
Mailing Address - Street 1:584 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-1709
Mailing Address - Country:US
Mailing Address - Phone:734-453-5588
Mailing Address - Fax:
Practice Address - Street 1:584 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-1709
Practice Address - Country:US
Practice Address - Phone:734-453-5588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty