Provider Demographics
NPI:1043339476
Name:TENDER CARE PEDIATRIC DENTISTRY LLC
Entity Type:Organization
Organization Name:TENDER CARE PEDIATRIC DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BEATRIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:DE LA ROCHE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:724-542-4818
Mailing Address - Street 1:6583 ROUTE 819 S
Mailing Address - Street 2:SUITE1
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:PA
Mailing Address - Zip Code:15666-3503
Mailing Address - Country:US
Mailing Address - Phone:724-542-4818
Mailing Address - Fax:724-542-4828
Practice Address - Street 1:6583 ROUTE 819 S
Practice Address - Street 2:SUITE1
Practice Address - City:MOUNT PLEASANT
Practice Address - State:PA
Practice Address - Zip Code:15666-3503
Practice Address - Country:US
Practice Address - Phone:724-542-4818
Practice Address - Fax:724-542-4828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS030164L1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000271462OtherUNITED CONCORDIA
PA2443009OtherAETNA DENTAL
PA000000191199Medicaid