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General NPI Number Information
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NPI Number | 1235776568
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Entity Type | Organization
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Legal Business Name | TRIBE DENTAL LLC
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Dates
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Enumeration Date | 12/05/2019
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Last Update Date | 01/05/2020
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Provider Practice Location Address
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Address Line | 11 MAGNOLIA COVE DR
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City | SIMPSONVILLE
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State | SC
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Zip | 29680
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Country | US
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Telephone | 864-610-4485
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Fax |
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Provider Business Mailing Address
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Address Line | 206 KILGORE FARMS CIR
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City | SIMPSONVILLE
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State | SC
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Zip | 29681-6389
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Country | US
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Telephone | 724-263-8210
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. LEANNA SHETLER
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Credential | DMD
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Telephone | 724-263-8210
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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