NPI | 1013265602 |
---|---|
Doing Business As | TOOTH FAIRY COTTAGE |
Entity Type | Organization |
Authorized Contact | KIMDUNG TRACY TRAN Owner 408-238-2647 |
Organization Subpart ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice |
Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 51778) |
1223P0221X Dentist, Pediatric Dentistry | |
Enumeration Date | 2012-08-29 |
Last Update Date | 2021-04-30 |