Provider Demographics
NPI:1497561468
Name:NAK TINY TEETH, PA
Entity type:Organization
Organization Name:NAK TINY TEETH, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE MANAGER ACCOUNTS & CREDEN
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:850-879-3605
Mailing Address - Street 1:1614 W PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5324
Mailing Address - Country:US
Mailing Address - Phone:850-792-9100
Mailing Address - Fax:850-378-5393
Practice Address - Street 1:1614 W PLAZA DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5324
Practice Address - Country:US
Practice Address - Phone:850-792-9100
Practice Address - Fax:850-378-5393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-05
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental