Provider Demographics
NPI:1629525001
Name:TLC DENTAL - HOLLYWOOD, LLC
Entity Type:Organization
Organization Name:TLC DENTAL - HOLLYWOOD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:MUCKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-650-1122
Mailing Address - Street 1:15 SARANAC RD
Mailing Address - Street 2:
Mailing Address - City:SEA RANCH LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33308-2910
Mailing Address - Country:US
Mailing Address - Phone:954-650-1122
Mailing Address - Fax:
Practice Address - Street 1:1718 SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-2275
Practice Address - Country:US
Practice Address - Phone:954-650-1122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENTAL PRACTICE MANAGEMENT, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-09-02
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty