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General NPI Number Information
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NPI Number | 1730211012
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Entity Type | Organization
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Legal Business Name | TLC DENTAL - DANIA, LLC
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Dates
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Enumeration Date | 03/12/2007
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Last Update Date | 09/06/2016
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Provider Practice Location Address
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Address Line | 435 E SHERIDAN ST
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City | DANIA
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State | FL
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Zip | 33004-5502
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Country | US
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Telephone | 954-926-5888
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Fax | 954-926-7913
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Provider Business Mailing Address
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Address Line | 15 SARANAC RD
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City | SEA RANCH LAKES
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State | FL
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Zip | 33308-2910
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Country | US
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Telephone | 954-650-1122
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Fax | 954-786-2726
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEVEN D MUCKEY
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Credential | DDS
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Telephone | 954-650-1122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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