Provider Demographics
NPI:1770323479
Name:TOOTH STUDIO & WELLNESS LLC
Entity type:Organization
Organization Name:TOOTH STUDIO & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:RYTEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:IPDH
Authorized Official - Phone:207-599-6459
Mailing Address - Street 1:576 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04009-4804
Mailing Address - Country:US
Mailing Address - Phone:207-599-6459
Mailing Address - Fax:
Practice Address - Street 1:576 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGTON
Practice Address - State:ME
Practice Address - Zip Code:04009-4804
Practice Address - Country:US
Practice Address - Phone:207-599-6459
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty