Provider Demographics
NPI:1013218411
Name:TNT DENTAL CARE
Entity Type:Organization
Organization Name:TNT DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:PHUONG
Authorized Official - Last Name:LAI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-923-0088
Mailing Address - Street 1:230 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-4301
Mailing Address - Country:US
Mailing Address - Phone:617-923-0088
Mailing Address - Fax:617-926-2598
Practice Address - Street 1:230 MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-4301
Practice Address - Country:US
Practice Address - Phone:617-923-0088
Practice Address - Fax:617-926-2598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-16
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21400122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty