Provider Demographics
NPI:1790229003
Name:TINGEY ORTHODONTICS
Entity type:Organization
Organization Name:TINGEY ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRELL
Authorized Official - Middle Name:F
Authorized Official - Last Name:TINGEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MSD
Authorized Official - Phone:208-375-0631
Mailing Address - Street 1:2020 N COLE RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-7309
Mailing Address - Country:US
Mailing Address - Phone:208-375-0631
Mailing Address - Fax:
Practice Address - Street 1:2020 N COLE RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-7309
Practice Address - Country:US
Practice Address - Phone:208-375-0631
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-06
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-17311223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty