Provider Demographics
NPI:1487462081
Name:TOOTH39 DENTAL GROUP PLLC
Entity type:Organization
Organization Name:TOOTH39 DENTAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RUBEN
Authorized Official - Middle Name:LEONARDO
Authorized Official - Last Name:KREBS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:239-258-4245
Mailing Address - Street 1:15455 COLLIER BLVD UNIT 104
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119-7874
Mailing Address - Country:US
Mailing Address - Phone:239-258-4245
Mailing Address - Fax:239-467-6050
Practice Address - Street 1:15455 COLLIER BLVD UNIT 104
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34119-7874
Practice Address - Country:US
Practice Address - Phone:239-258-4245
Practice Address - Fax:239-467-6050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-28
Last Update Date:2024-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental