Provider Demographics
NPI:1386458636
Name:TOOTH TOWN LLC
Entity type:Organization
Organization Name:TOOTH TOWN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ONAEDO
Authorized Official - Middle Name:
Authorized Official - Last Name:ACHEBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-740-9607
Mailing Address - Street 1:1803 WYANDOTTE ST APT 205
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108-2553
Mailing Address - Country:US
Mailing Address - Phone:646-740-9607
Mailing Address - Fax:
Practice Address - Street 1:4000 S RANGE LINE RD
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-5329
Practice Address - Country:US
Practice Address - Phone:646-740-9607
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-06
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty