Provider Demographics
NPI:1598262917
Name:A TENDER DENTAL CARE V LLC
Entity Type:Organization
Organization Name:A TENDER DENTAL CARE V LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:A
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-824-8165
Mailing Address - Street 1:25355 N LAKE PLEASANT PKWY UNIT 103
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-1504
Mailing Address - Country:US
Mailing Address - Phone:480-824-8165
Mailing Address - Fax:
Practice Address - Street 1:25355 N LAKE PLEASANT PKWY UNIT 103
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-1504
Practice Address - Country:US
Practice Address - Phone:480-824-8165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-11
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental