Provider Demographics
NPI:1225549363
Name:TLC DENTAL LLC
Entity Type:Organization
Organization Name:TLC DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAVITHRI
Authorized Official - Middle Name:
Authorized Official - Last Name:RAJU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-423-2525
Mailing Address - Street 1:7908 CARNEGIE BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-5781
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7908 CARNEGIE BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-5781
Practice Address - Country:US
Practice Address - Phone:260-423-2525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TLC DENTAL LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-10-16
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental