Organization
TOOTH FAIRY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERESA L POORMAN DDS (DENTIST)
(308) 234-5437
Entity
Organization
Contact information
Practice address
121 E 31ST ST, KEARNEY, NE 68847-3001
(308) 234-5437
(308) 234-3169
Mailing address
121 E 31ST ST, KEARNEY, NE 68847-3001
(308) 234-5437
(308) 234-3169
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
5646
NE
Other
Enumeration date
04/03/2012
Last updated
04/03/2012
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