Provider Demographics
NPI:1538674262
Name:TERCEL DENTAL PLLC
Entity Type:Organization
Organization Name:TERCEL DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MATZDORFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-445-8569
Mailing Address - Street 1:643 GOLD STAR HWY.
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340
Mailing Address - Country:US
Mailing Address - Phone:860-445-8569
Mailing Address - Fax:860-446-8434
Practice Address - Street 1:643 GOLD STAR HWY.
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340
Practice Address - Country:US
Practice Address - Phone:860-445-8569
Practice Address - Fax:860-446-8434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-04
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty