Provider Demographics
NPI:1497478523
Name:TDN DENTISTRY, PLLC
Entity Type:Organization
Organization Name:TDN DENTISTRY, PLLC
Other - Org Name:CONTEMPORARY PERIODONTICS & IMPLANT DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:DEMINT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-692-2224
Mailing Address - Street 1:1 N DALE MABRY HWY STE 605
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-2781
Mailing Address - Country:US
Mailing Address - Phone:813-692-2205
Mailing Address - Fax:813-692-2205
Practice Address - Street 1:8487 4TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-3609
Practice Address - Country:US
Practice Address - Phone:727-579-8487
Practice Address - Fax:727-578-8500
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TDN DENTISTRY, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-09-23
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty