Provider Demographics
NPI:1932964400
Name:TD DENTAL LLC
Entity Type:Organization
Organization Name:TD DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:HEISLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-636-5600
Mailing Address - Street 1:PO BOX 147
Mailing Address - Street 2:
Mailing Address - City:BAIRDFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15006-0147
Mailing Address - Country:US
Mailing Address - Phone:724-636-5600
Mailing Address - Fax:
Practice Address - Street 1:2627 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365-1507
Practice Address - Country:US
Practice Address - Phone:937-284-4728
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-14
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty