Provider Demographics
NPI:1316512601
Name:TOOTH CO
Entity type:Organization
Organization Name:TOOTH CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BRION
Authorized Official - Middle Name:
Authorized Official - Last Name:CONWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-647-3707
Mailing Address - Street 1:4575 S 5600 W STE B
Mailing Address - Street 2:
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84120-4639
Mailing Address - Country:US
Mailing Address - Phone:801-955-4400
Mailing Address - Fax:801-955-4900
Practice Address - Street 1:4575 S 5600 W STE B
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84120-4639
Practice Address - Country:US
Practice Address - Phone:801-955-4400
Practice Address - Fax:801-955-4900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental