1841627825 NPI number — TILDEN BAY JOSEPH DENTAL GROUP

Table of content: (NPI 1841627825)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841627825 NPI number — TILDEN BAY JOSEPH DENTAL GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TILDEN BAY JOSEPH DENTAL GROUP
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:
6
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:
1841627825
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/14/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2934 1/2 BEVERLY GLEN CIRCLE STE #451
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90077
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-576-6143
Provider Business Mailing Address Fax Number:
707-639-8633

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14401 BURBANK BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHERMAN OAKS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91401-4824
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-782-9500
Provider Business Practice Location Address Fax Number:
707-639-8633
Provider Enumeration Date:
10/04/2013

Additional Information

Authorized Official

Authorized Official Last Name:
CARO
Authorized Official First Name:
YOLANDA
Authorized Official Middle Name:
Authorized Official Title or Position:
INSURANCE BILLER
Authorized Official Telephone Number:
323-576-6143

Provider Taxonomy Codes

  • Taxonomy code: 122300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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