Organization
TDC PORT ST.LUCIE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JORDAN TOMALTY DMD (OWNER/DENTIST)
(561) 777-8980
Entity
Organization
Contact information
Practice address
1385 SW GATLIN BLVD, PORT ST LUCIE, FL 34953-4102
(561) 777-8980
Mailing address
1385 SW GATLIN BLVD, PORT ST LUCIE, FL 34953-4102
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
03/27/2017
Last updated
03/27/2017
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