Provider Demographics
NPI:1205543857
Name:TDK DENTAL LLC DBA FAMILY FRIENDLY DENTAL
Entity type:Organization
Organization Name:TDK DENTAL LLC DBA FAMILY FRIENDLY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TSVETELINA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:973-884-1046
Mailing Address - Street 1:1 HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:KEARNY
Mailing Address - State:NJ
Mailing Address - Zip Code:07032-1804
Mailing Address - Country:US
Mailing Address - Phone:401-864-0033
Mailing Address - Fax:
Practice Address - Street 1:470 RIDGEDALE AVE
Practice Address - Street 2:
Practice Address - City:EAST HANOVER
Practice Address - State:NJ
Practice Address - Zip Code:07936-3074
Practice Address - Country:US
Practice Address - Phone:973-884-1046
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental