Provider Demographics
NPI:1750811584
Name:TOOTH B.U.D.D.S., INC.
Entity type:Organization
Organization Name:TOOTH B.U.D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN/PROGRAM ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MIQUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCRAE
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:928-965-1534
Mailing Address - Street 1:PO BOX 937
Mailing Address - Street 2:
Mailing Address - City:PIMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85543-0937
Mailing Address - Country:US
Mailing Address - Phone:928-965-1534
Mailing Address - Fax:
Practice Address - Street 1:168 S. 900 W.
Practice Address - Street 2:
Practice Address - City:PIMA
Practice Address - State:AZ
Practice Address - Zip Code:85543
Practice Address - Country:US
Practice Address - Phone:928-965-1534
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-14
Last Update Date:2017-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty