Provider Demographics
NPI:1790400406
Name:TDN DENTISTRY, PLLC
Entity Type:Organization
Organization Name:TDN DENTISTRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:DEMINT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-692-2224
Mailing Address - Street 1:1 N DALE MABRY HWY STE 605
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-2781
Mailing Address - Country:US
Mailing Address - Phone:813-692-2200
Mailing Address - Fax:813-692-2205
Practice Address - Street 1:322 S 6TH AVE
Practice Address - Street 2:
Practice Address - City:WAUCHULA
Practice Address - State:FL
Practice Address - Zip Code:33873-3207
Practice Address - Country:US
Practice Address - Phone:863-773-9344
Practice Address - Fax:863-773-9350
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TDN DENTISTRY, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty