Provider Demographics
NPI:1528897865
Name:TRAVELING TOOTH FAIRIES
Entity type:Organization
Organization Name:TRAVELING TOOTH FAIRIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MYRA
Authorized Official - Middle Name:
Authorized Official - Last Name:NIKITAS
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:603-566-4294
Mailing Address - Street 1:19 ROYAL OAK DR
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03064-1660
Mailing Address - Country:US
Mailing Address - Phone:603-533-4294
Mailing Address - Fax:
Practice Address - Street 1:141 LEDGE ST
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-3073
Practice Address - Country:US
Practice Address - Phone:603-566-4294
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental