Provider Demographics
NPI:1770592594
Name:CARL L TINKLEMAN DMD PC
Entity type:Organization
Organization Name:CARL L TINKLEMAN DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:B
Authorized Official - Last Name:WOLGIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:215-735-1131
Mailing Address - Street 1:255 S 17TH STREET
Mailing Address - Street 2:SUITE 1806
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103
Mailing Address - Country:US
Mailing Address - Phone:215-735-1131
Mailing Address - Fax:215-735-9892
Practice Address - Street 1:255 S 17TH STREET
Practice Address - Street 2:SUITE 1806
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103
Practice Address - Country:US
Practice Address - Phone:215-735-1131
Practice Address - Fax:215-735-9892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS030806L122300000X
PADS028500L122300000X
PADS15962L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty