Provider Demographics
NPI:1376370791
Name:TLG DENTAL GROUP
Entity type:Organization
Organization Name:TLG DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:TAOUFIK
Authorized Official - Middle Name:
Authorized Official - Last Name:FADDOUL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:661-808-0181
Mailing Address - Street 1:430 PUEBLO PINTADO
Mailing Address - Street 2:
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-4725
Mailing Address - Country:US
Mailing Address - Phone:661-808-0181
Mailing Address - Fax:
Practice Address - Street 1:3293 WURZBACH RD # 103
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-4002
Practice Address - Country:US
Practice Address - Phone:661-808-0181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty