Organization
LTC DENTAL
Active
Other names
LTC Dental
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TARA ROBINSON (OWNER)
(407) 375-3003
Entity
Organization
Contact information
Practice address
4060 S LAKE DR APT 4, SAINT FRANCIS, WI 53235-5256
(407) 375-3003
(800) 863-5373
Mailing address
4060 S LAKE DR APT 4, SAINT FRANCIS, WI 53235-5256
(407) 375-3003
(800) 863-5373
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
01/28/2021
Last updated
01/28/2021
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