Provider Demographics
NPI:1457062143
Name:TDC DENTISTRY
Entity Type:Organization
Organization Name:TDC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIELA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-834-6609
Mailing Address - Street 1:1455 BROAD ST STE 105
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-3039
Mailing Address - Country:US
Mailing Address - Phone:973-834-6609
Mailing Address - Fax:973-834-6709
Practice Address - Street 1:1455 BROAD ST STE 105
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-3039
Practice Address - Country:US
Practice Address - Phone:973-834-6609
Practice Address - Fax:973-834-6709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-13
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental