Organization
LTC DENTAL II LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TARA ROBINSON (CHIEF EXECUTE OFFICER)
(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
122300000X
Dentist
Primary
—
—
124Q00000X
Dental Hygienist
—
—
Other
Enumeration date
11/22/2021
Last updated
11/22/2021
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