MEDICARE: TWEEDY DENTAL CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1194121186
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TWEEDY DENTAL CARE

Provider Business Mailing Address
First Line	:	4355 TWEEDY BLVD
Second Line	:
City	:	SOUTH GATE
State	:	CA
Zip	:	90280-6236
Country	:	US
Telephone Number	:	323-484-9923
Fax Number	:

Provider Business Practice Location Address
First Line	:	4355 TWEEDY BLVD
Second Line	:
City	:	SOUTH GATE
State	:	CA
Zip	:	90280-6236
Country	:	US
Telephone Number	:	323-484-9923
Fax Number	:

Authorized Official
Title or Position	:	C.E.O
Name	:	MISS STELLA MARISOL HERRERA
Credential	:
Telephone Number	:	626-428-8819

Provider Enumeration Date	:	11/18/2014
Last Update Date	:	11/18/2014

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Directions to “TWEEDY DENTAL CARE ” Practice Location

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