Provider Demographics
NPI:1104356187
Name:TENDER DENTAL MANAGEMENT, LLC
Entity type:Organization
Organization Name:TENDER DENTAL MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JONG
Authorized Official - Middle Name:
Authorized Official - Last Name:UM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:860-325-0022
Mailing Address - Street 1:301 COMMONS PARK S UNIT 618
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-7088
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5001 E BONANZA RD STE 160
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89110-3560
Practice Address - Country:US
Practice Address - Phone:860-325-0022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-13
Last Update Date:2017-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV68831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty