Healthcare Provider Details

I. General information

NPI: 1932890571
Provider Name (Legal Business Name): TDC PLANTATION, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2023
Last Update Date: 05/16/2023
Certification Date: 05/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8962 CLEARY BLVD
PLANTATION FL
33324-1307
US

IV. Provider business mailing address

8962 CLEARY BLVD
PLANTATION FL
33324-1307
US

V. Phone/Fax

Practice location:
  • Phone: 954-915-8080
  • Fax: 954-915-0171
Mailing address:
  • Phone: 954-915-8080
  • Fax: 954-915-0171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JORDAN TOMALTY
Title or Position: OWNER
Credential: DMD
Phone: 561-633-9676