Provider Demographics
NPI:1073689899
Name:TENDER DENTAL CARE PC
Entity Type:Organization
Organization Name:TENDER DENTAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:PRABHA
Authorized Official - Middle Name:R
Authorized Official - Last Name:RAJU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:810-715-3368
Mailing Address - Street 1:PO BOX 90161
Mailing Address - Street 2:1024 N GENESEE
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48509
Mailing Address - Country:US
Mailing Address - Phone:810-715-3368
Mailing Address - Fax:810-715-1663
Practice Address - Street 1:1024 N GENESEE
Practice Address - Street 2:
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48509
Practice Address - Country:US
Practice Address - Phone:810-715-3368
Practice Address - Fax:810-715-1663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI159241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty