Provider Demographics
NPI:1821305988
Name:SENIOR DENTAL CARE, LLC
Entity Type:Organization
Organization Name:SENIOR DENTAL CARE, LLC
Other - Org Name:SENIOR DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTAL HYGIENIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CASSI
Authorized Official - Middle Name:LAYNE
Authorized Official - Last Name:COPELAND
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:850-674-1212
Mailing Address - Street 1:20120 CENTRAL AVEWEST
Mailing Address - Street 2:
Mailing Address - City:BLOUNTSTOWN
Mailing Address - State:FL
Mailing Address - Zip Code:32424
Mailing Address - Country:US
Mailing Address - Phone:850-674-1212
Mailing Address - Fax:850-674-2951
Practice Address - Street 1:20120 CENTRAL AVEWEST
Practice Address - Street 2:
Practice Address - City:BLOUNTSTOWN
Practice Address - State:FL
Practice Address - Zip Code:32424
Practice Address - Country:US
Practice Address - Phone:850-674-1212
Practice Address - Fax:850-674-2951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-09
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty