Organization
TOOTH FAIRY PEDIATRIC DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUHO LEE DDS (OWNER)
(203) 403-2525
Entity
Organization
Contact information
Practice address
35 COPPS HILL RD, SUITE 6, RIDGEFIELD, CT 06877-4041
(203) 403-2525
(203) 403-2545
Mailing address
35 COPPS HILL RD, SUITE 6, RIDGEFIELD, CT 06877-4041
(203) 403-2525
(203) 403-2545
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
1223D0004X
Dental Anesthesiology
—
CT
1223P0221X
Pediatric Dentistry
Primary
9091
CT
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
9135
CT
Other
Enumeration date
02/26/2009
Last updated
11/24/2014
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