TDC Port St. Lucie LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

TDC PORT ST. LUCIE LLC

Practice address

1161 SE Port St Lucie Blvd
Port St Lucie, FL 34952-5332

Phone

(772) 335-7766

NPI assigned

May 1, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Sean Tomalty, DMD

Title

Ceo

Phone

(561) 789-6611

Specialties & licenses 3

Addresses

Other names 1

• Rivergate Dental Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mark Allen Edwards, DDS

  • Dentist
  • Port St Lucie, FL
  • NPI 1972606341
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1556668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1556668800000",
    "number": "1003471459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8794 W BOYNTON BEACH BLVD STE 110",
            "city": "BOYNTON BEACH",
            "state": "FL",
            "postal_code": "334724468",
            "telephone_number": "561-777-8980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1161 SE PORT ST LUCIE BLVD",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349525332",
            "telephone_number": "772-335-7766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TDC PORT ST. LUCIE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-01",
        "last_updated": "2019-05-01",
        "status": "A",
        "authorized_official_last_name": "TOMALTY",
        "authorized_official_first_name": "SEAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "561-789-6611",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Endodontics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rivergate Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Niurka Ramirez Taylor
• Regan Marquis Taylor
• Velma Joyce Taylor
• TC Physicians LLC
• TDC Ocean Dental, PLLC
• TDC Port St.Lucie LLC
• Teach Skills & Empower, LLC
• Julie Teigen, APRN
• Jennifer Corona Teitelbaum
• Martin D Tejada, LCSW

• General Practice Dentistry in Port St Lucie, FL
• Providers in Port St Lucie, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.