Provider Demographics
NPI:1699941328
Name:TOOTHTIME FAMILY DENTISTRY PLLC
Entity type:Organization
Organization Name:TOOTHTIME FAMILY DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:830-625-6410
Mailing Address - Street 1:1280 E COMMON ST
Mailing Address - Street 2:STE A
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-3509
Mailing Address - Country:US
Mailing Address - Phone:830-625-6410
Mailing Address - Fax:830-626-3545
Practice Address - Street 1:1280 E COMMON ST
Practice Address - Street 2:STE A
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-3509
Practice Address - Country:US
Practice Address - Phone:830-625-6410
Practice Address - Fax:830-626-3545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-02
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX192071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX009499705Medicaid