Provider Demographics
NPI:1104500743
Name:SUPER TOOTH PEDIATRIC DENTISTRY
Entity type:Organization
Organization Name:SUPER TOOTH PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:IVKER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:267-808-4446
Mailing Address - Street 1:2943 SWEDE RD
Mailing Address - Street 2:
Mailing Address - City:EAST NORRITON
Mailing Address - State:PA
Mailing Address - Zip Code:19401-1335
Mailing Address - Country:US
Mailing Address - Phone:267-808-4446
Mailing Address - Fax:
Practice Address - Street 1:2943 SWEDE RD
Practice Address - Street 2:
Practice Address - City:EAST NORRITON
Practice Address - State:PA
Practice Address - Zip Code:19401-1335
Practice Address - Country:US
Practice Address - Phone:267-808-4446
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty