MEDICARE: TILDEN BAY JOSEPH DENTAL GROUP

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	122300000X	Dentist
2	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1841627825
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TILDEN BAY JOSEPH DENTAL GROUP

Provider Business Mailing Address
First Line	:	2934 1/2 BEVERLY GLEN CIRCLE STE #451
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90077
Country	:	US
Telephone Number	:	323-576-6143
Fax Number	:	707-639-8633

Provider Business Practice Location Address
First Line	:	14401 BURBANK BLVD
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91401-4824
Country	:	US
Telephone Number	:	818-782-9500
Fax Number	:	707-639-8633

Authorized Official
Title or Position	:	INSURANCE BILLER
Name	:	YOLANDA CARO
Credential	:
Telephone Number	:	323-576-6143

Provider Enumeration Date	:	10/04/2013
Last Update Date	:	09/02/2025

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