Provider Demographics
NPI:1770033086
Name:TOTAL DENTAL CARE, LLP
Entity Type:Organization
Organization Name:TOTAL DENTAL CARE, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KEISHA
Authorized Official - Middle Name:BROOKE
Authorized Official - Last Name:TAMAR-LOCKWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-806-8060
Mailing Address - Street 1:1822 E NC HIGHWAY 54
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-3210
Mailing Address - Country:US
Mailing Address - Phone:919-806-8060
Mailing Address - Fax:919-806-8449
Practice Address - Street 1:1822 E NC HIGHWAY 54
Practice Address - Street 2:SUITE 100
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-3210
Practice Address - Country:US
Practice Address - Phone:919-806-8060
Practice Address - Fax:919-806-8449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-11
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7271122300000X
NC8867122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty