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Organization
TLC DENTAL CENTER LLC
Active
Organization
TLC DENTAL CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HAE SU YIM D.M.D. (OWNER, DENTIST)
(937) 642-2400
Entity
Organization
Contact information
Practice address
1127 W 5TH ST, MARYSVILLE, OH 43040-9282
(937) 642-2400
(937) 642-2490
Mailing address
1127 W 5TH ST, MARYSVILLE, OH 43040-9282
(937) 642-2400
(937) 642-2490
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
30-022153
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
179363 - LOCATION #
MOLINA HEALTHCARE OF OHIO
OH
05
—
2572470
—
OH
Enumeration date
05/19/2008
Last updated
05/19/2008
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