Provider Demographics
NPI:1457063604
Name:TOOTHMOVER ORTHODONTICS
Entity Type:Organization
Organization Name:TOOTHMOVER ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:217-546-9600
Mailing Address - Street 1:997 CLOCK TOWER DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-1301
Mailing Address - Country:US
Mailing Address - Phone:217-546-9600
Mailing Address - Fax:217-546-9642
Practice Address - Street 1:997 CLOCK TOWER DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-1301
Practice Address - Country:US
Practice Address - Phone:217-546-9600
Practice Address - Fax:217-546-9642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-20
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental