Provider Demographics
NPI:1972946788
Name:TINY TEETH, PC
Entity type:Organization
Organization Name:TINY TEETH, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:FAIRCHILD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:208-690-0366
Mailing Address - Street 1:11149 RESEARCH BLVD
Mailing Address - Street 2:SUITE 270
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-5279
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11149 RESEARCH BLVD
Practice Address - Street 2:SUITE 270
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-5279
Practice Address - Country:US
Practice Address - Phone:512-346-1221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-10
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX286291223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty