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Organization
TDC PORT ST. LUCIE LLC
Active
Organization
TDC PORT ST. LUCIE LLC
Active
Other names
Rivergate Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SEAN TOMALTY DMD (CEO)
(561) 789-6611
Entity
Organization
Contact information
Practice address
1161 SE PORT ST LUCIE BLVD, PORT ST LUCIE, FL 34952-5332
(772) 335-7766
Mailing address
8794 W BOYNTON BEACH BLVD STE 110, BOYNTON BEACH, FL 33472-4468
(561) 777-8980
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
—
—
1223G0001X
General Practice Dentistry
Primary
—
—
1223P0300X
Periodontics
—
—
Other
Enumeration date
05/01/2019
Last updated
05/01/2019
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