Provider Demographics
NPI:1730662669
Name:TLC DENTAL 4 KIDS, LLC
Entity Type:Organization
Organization Name:TLC DENTAL 4 KIDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MUCKEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:954-494-8502
Mailing Address - Street 1:1001 W CYPRESS CREEK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-1950
Mailing Address - Country:US
Mailing Address - Phone:954-494-8502
Mailing Address - Fax:
Practice Address - Street 1:3001 E COMMERCIAL BLVD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4311
Practice Address - Country:US
Practice Address - Phone:954-491-7100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-06
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty