Provider Demographics
NPI:1700654241
Name:TONGUE TIE INSTITUTE
Entity type:Organization
Organization Name:TONGUE TIE INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:FREITAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:954-505-7378
Mailing Address - Street 1:17901 NW 5TH ST STE 202
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-2810
Mailing Address - Country:US
Mailing Address - Phone:954-505-7378
Mailing Address - Fax:954-231-0237
Practice Address - Street 1:17901 NW 5TH ST STE 202
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-2810
Practice Address - Country:US
Practice Address - Phone:954-505-7378
Practice Address - Fax:954-231-0237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-14
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental