| NPI | 1588981229 |
|---|---|
| Doing Business As | TOOTH FAIRY DENTAL |
| Entity Type | Organization |
| Authorized Contact | MARIA ELOISA ILAGAN Owner/Dentist 818-365-3004 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: CA 46831) |
| Enumeration Date | 2010-04-20 |
| Last Update Date | 2010-04-20 |