Provider Demographics
NPI:1871211672
Name:TOOTH KIDS LLC
Entity type:Organization
Organization Name:TOOTH KIDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ ACTIVE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:J
Authorized Official - Middle Name:ROCKWELL
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-254-9566
Mailing Address - Street 1:2747 E UNIVERSITY DR. BOX #2399
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85213
Mailing Address - Country:US
Mailing Address - Phone:480-254-9566
Mailing Address - Fax:
Practice Address - Street 1:4055 W CHANDLER BLVD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-3700
Practice Address - Country:US
Practice Address - Phone:480-254-9566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-17
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty