Organization
TD DENTAL GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANELIS BLANCO DMD (PRESIDENT)
(239) 317-8333
Entity
Organization
Contact information
Practice address
28410 CROSSING BLVD, SUIT 230, BONITA SPRINGS, FL 34135
(239) 317-8333
(239) 317-8334
Mailing address
28410 CROSSING BLVD, SUIT 230, BONITA SPRINGS, FL 34135
(239) 317-8333
(239) 317-8334
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
08/04/2020
Last updated
08/04/2020
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