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General NPI Number Information
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NPI Number | 1255950382
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Entity Type | Organization
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Legal Business Name | TRANQUILITY DENTAL CARE PLLC
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Dates
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Enumeration Date | 04/09/2020
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Last Update Date | 04/09/2020
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Provider Practice Location Address
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Address Line | 301 OXFORD VALLEY RD # 1301
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City | YARDLEY
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State | PA
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Zip | 19067-7706
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Country | US
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Telephone | 267-392-5815
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Fax |
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Provider Business Mailing Address
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Address Line | 301 OXFORD VALLEY RD # 1301
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City | YARDLEY
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State | PA
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Zip | 19067-7706
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Country | US
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Telephone | 267-392-5815
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | SERGEY DEDOV
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Credential | DDS
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Telephone | 267-632-1852
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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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