| Tooth Fairy Land Dba | |
|
10205 South Dixie Highway Suite 200/201 Pinecrest FL 33156 | |
| (305) 279-4312 | |
| (305) 596-6632 |
| Full Name | Tooth Fairy Land Dba |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 10205 South Dixie Highway Suite 200/201, Pinecrest, Florida |
| Authorized Official Name and Position | Bayardo Cortes (DR OWNER) |
| Authorized Official Contact | 3052794312 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Tooth Fairy Land Dba 10205 South Dixie Highway Suite 200/201 Pinecrest FL 33156 Ph: (305) 279-4312 | Tooth Fairy Land Dba 10205 South Dixie Highway Suite 200/201 Pinecrest FL 33156 Ph: (305) 279-4312 |
| NPI Number | 1659616233 |
|---|---|
| Provider Enumeration Date | 12/07/2012 |
| Last Update Date | 07/28/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659616233 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | DN15894 (Florida) | Primary |
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