Provider Demographics
NPI:1013702661
Name:TATE DENTAL LLC
Entity type:Organization
Organization Name:TATE DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINEE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:REGGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TATE
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:614-563-6542
Mailing Address - Street 1:5770 KARL RD STE 100
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-3658
Mailing Address - Country:US
Mailing Address - Phone:614-846-8340
Mailing Address - Fax:614-846-8345
Practice Address - Street 1:5770 KARL RD STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-3658
Practice Address - Country:US
Practice Address - Phone:614-846-8340
Practice Address - Fax:614-846-8345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental