Healthcare Provider Details

I. General information

NPI: 1790551398
Provider Name (Legal Business Name): TEC DENTAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2023
Last Update Date: 11/27/2023
Certification Date: 11/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 WALNUT ST STE 402
PHILADELPHIA PA
19102-2903
US

IV. Provider business mailing address

500 CHAPMAN ST
CANTON MA
02021-2093
US

V. Phone/Fax

Practice location:
  • Phone: 215-972-0181
  • Fax:
Mailing address:
  • Phone: 781-562-3442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: KERSTIN MARRAMA
Title or Position: VP OF HR
Credential:
Phone: 781-562-3442