NPIMap

Organization Active NPI

Tooth Fairy PC

  • Pediatric Dentistry
  • Kearney, NE
National Provider Identifier
1316203433
Registry record updated Apr 3, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
5646 Issued in NE
Legal business name
TOOTH FAIRY PC
Practice address
121 E 31St St
Kearney, NE 68847-3001
Phone
(308) 234-5437
Fax
(308) 234-3169
NPI assigned
Apr 3, 2012
Last updated
Apr 3, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Teresa L Poorman, DDSNPI 1154431591
Title
Dentist
Phone
(308) 234-5437

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X 5646 NE Primary

Addresses

Primary practice location

121 E 31St St
Kearney, NE 68847-3001

Mailing address

121 E 31St St
Kearney, NE 68847-3001
Phone (308) 234-5437

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1333411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1333411200000",
    "number": "1316203433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 E 31ST ST",
            "city": "KEARNEY",
            "state": "NE",
            "postal_code": "688473001",
            "telephone_number": "308-234-5437",
            "fax_number": "308-234-3169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 E 31ST ST",
            "city": "KEARNEY",
            "state": "NE",
            "postal_code": "688473001",
            "telephone_number": "308-234-5437",
            "fax_number": "308-234-3169"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TOOTH FAIRY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-03",
        "last_updated": "2012-04-03",
        "status": "A",
        "authorized_official_last_name": "POORMAN",
        "authorized_official_first_name": "TERESA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "308-234-5437",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NE",
            "license": "5646",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kearney, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.