Healthcare Provider Details

I. General information

NPI: 1407827512
Provider Name (Legal Business Name): DAVID I. TINDLE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 07/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 N UNIVERSITY AVE DEPT PERIODONTICS AND ORAL MEDICINE
ANN ARBOR MI
48109-1078
US

IV. Provider business mailing address

1011 N UNIVERSITY AVE DEPT PERIODONTICS AND ORAL MEDICINE
ANN ARBOR MI
48109-1078
US

V. Phone/Fax

Practice location:
  • Phone: 734-764-1543
  • Fax:
Mailing address:
  • Phone: 734-764-1543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number15878
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number52527
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901020334
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: