TLC Pediatric Dentistry, Inc.

Primary specialty

Preferred Provider OrganizationTaxonomy code 305R00000X

License

B15486 Issued in FL

Legal business name

TLC PEDIATRIC DENTISTRY, INC.

Practice address

3223 S Dale Mabry Hwy
Tampa, FL 33629-7815

Phone

(813) 876-4370

NPI assigned

Jun 2, 2016

Organization subpart

No

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

Authorized official

Name

Dwight Sanjuan, DMD

Title

President

Phone

(813) 876-4370

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1464825600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1464825600000",
    "number": "1861840654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3223 S DALE MABRY HWY",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336297815",
            "telephone_number": "813-876-4370"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3223 S DALE MABRY HWY",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336297815",
            "telephone_number": "813-876-4370"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TLC PEDIATRIC DENTISTRY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-02",
        "last_updated": "2016-06-02",
        "status": "A",
        "authorized_official_last_name": "SANJUAN",
        "authorized_official_first_name": "DWIGHT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "813-876-4370",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "FL",
            "license": "B15486",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Preferred Provider Organization in Tampa, FL
• Providers in Tampa, FL by specialty
• Preferred Provider Organization in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2016; 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.