Organization
TLC PEDIATRIC DENTISTRY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DWIGHT SANJUAN DMD (PRESIDENT)
(813) 876-4370
Entity
Organization
Contact information
Practice address
3223 S DALE MABRY HWY, TAMPA, FL 33629-7815
(813) 876-4370
Mailing address
3223 S DALE MABRY HWY, TAMPA, FL 33629-7815
(813) 876-4370
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
B15486
FL
Other
Enumeration date
06/02/2016
Last updated
06/02/2016
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