Provider Demographics
NPI:1841925526
Name:TOOTHASAURUS CHILDRENS DENTISRTY
Entity type:Organization
Organization Name:TOOTHASAURUS CHILDRENS DENTISRTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TIERNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:PETTINATO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:813-778-3140
Mailing Address - Street 1:5256 VILLAGE MARKET
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-8400
Mailing Address - Country:US
Mailing Address - Phone:813-907-3100
Mailing Address - Fax:
Practice Address - Street 1:5256 VILLAGE MARKET
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-8400
Practice Address - Country:US
Practice Address - Phone:813-907-3100
Practice Address - Fax:813-907-3110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-18
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1629131230OtherNPI #
FL1912921867OtherNPI#
FL1346303948OtherNPI #