Provider Demographics
NPI:1114348323
Name:MINELLE M. TENDLER DMD PA
Entity Type:Organization
Organization Name:MINELLE M. TENDLER DMD PA
Other - Org Name:TENDLER ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MINELLE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:TENDLER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:561-826-7955
Mailing Address - Street 1:595 S FEDERAL HWY STE 130
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-6096
Mailing Address - Country:US
Mailing Address - Phone:561-826-7955
Mailing Address - Fax:561-826-7957
Practice Address - Street 1:595 S FEDERAL HWY STE 130
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-6096
Practice Address - Country:US
Practice Address - Phone:561-826-7955
Practice Address - Fax:561-826-7957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-16
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1223S0112X
FLDN176651223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty