1043339476 NPI number — TENDER CARE PEDIATRIC DENTISTRY LLC

Table of content: (NPI 1043339476)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043339476 NPI number — TENDER CARE PEDIATRIC DENTISTRY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TENDER CARE PEDIATRIC DENTISTRY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043339476
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/13/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6583 ROUTE 819 S
Provider Second Line Business Mailing Address:
SUITE1
Provider Business Mailing Address City Name:
MOUNT PLEASANT
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15666-3503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-542-4818
Provider Business Mailing Address Fax Number:
724-542-4828

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6583 ROUTE 819 S
Provider Second Line Business Practice Location Address:
SUITE1
Provider Business Practice Location Address City Name:
MOUNT PLEASANT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15666-3503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-542-4818
Provider Business Practice Location Address Fax Number:
724-542-4828
Provider Enumeration Date:
03/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DE LA ROCHE
Authorized Official First Name:
BEATRIZ
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
724-542-4818

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X , with the licence number:  DS030164L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000271462 . This is a "UNITED CONCORDIA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2443009 . This is a "AETNA DENTAL" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 000000191199 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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