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General NPI Number Information
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NPI Number | 1043183601
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Entity Type | Organization
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Legal Business Name | TDC OF WEST CAPE CORAL PLLC
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Dates
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Enumeration Date | 09/29/2025
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Last Update Date | 09/29/2025
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Provider Practice Location Address
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Address Line | 2534 SE SANTA BARBARA PL STE 202
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City | CAPE CORAL
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State | FL
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Zip | 33904-2709
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Country | US
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Telephone | 239-800-3332
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Fax |
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Provider Business Mailing Address
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Address Line | 2534 SE SANTA BARBARA PL STE 202
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City | CAPE CORAL
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State | FL
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Zip | 33904-2709
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Country | US
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Telephone | 239-800-3332
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JORDAN TOMALTY
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Credential |
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Telephone | 561-633-9676
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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