Healthcare Provider Details

I. General information

NPI: 1457062143
Provider Name (Legal Business Name): TDC DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2022
Last Update Date: 01/31/2023
Certification Date: 01/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1455 BROAD ST STE 105
BLOOMFIELD NJ
07003-3039
US

IV. Provider business mailing address

1455 BROAD ST STE 105
BLOOMFIELD NJ
07003-3039
US

V. Phone/Fax

Practice location:
  • Phone: 973-834-6609
  • Fax: 973-834-6709
Mailing address:
  • Phone: 973-834-6609
  • Fax: 973-834-6709

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: DANIELA BOWER
Title or Position: BILLING COORDINATOR
Credential:
Phone: 973-834-6609