Provider Demographics
NPI:1710585815
Name:TPG DMD, LLC
Entity Type:Organization
Organization Name:TPG DMD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:570-367-9901
Mailing Address - Street 1:5 KNOLLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19608
Mailing Address - Country:US
Mailing Address - Phone:570-367-9901
Mailing Address - Fax:
Practice Address - Street 1:GRANDE PLAZA 1103 ROCKY DR
Practice Address - Street 2:SUITE 205
Practice Address - City:WEST LAWN
Practice Address - State:PA
Practice Address - Zip Code:19609
Practice Address - Country:US
Practice Address - Phone:570-367-9901
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-12
Last Update Date:2020-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental