Organization
THE TOOTH FAIRIES 2 LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HELEN ELISE TANNER RDH, BS (PRESIDENT)
(425) 417-0630
Entity
Organization
Contact information
Practice address
1840 25TH AVE NE APT 414, ISSAQUAH, WA 98029-2641
(425) 417-0630
Mailing address
1840 25TH AVE NE APT 414, ISSAQUAH, WA 98029-2641
(425) 417-0630
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
DH00005026
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5901897
—
WA
Enumeration date
08/20/2009
Last updated
08/20/2009
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