Provider Demographics
NPI:1730211988
Name:TLC DENTAL - LAUDERHILL, LC
Entity type:Organization
Organization Name:TLC DENTAL - LAUDERHILL, LC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:MUCKEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:954-650-1122
Mailing Address - Street 1:15 SARANAC RD
Mailing Address - Street 2:
Mailing Address - City:SEA RANCH LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33308-2910
Mailing Address - Country:US
Mailing Address - Phone:954-650-1122
Mailing Address - Fax:954-786-2726
Practice Address - Street 1:2331 N STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33313
Practice Address - Country:US
Practice Address - Phone:954-486-6989
Practice Address - Fax:954-486-6992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN8582122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty