Provider Demographics
NPI:1194121186
Name:TWEEDY DENTAL CARE
Entity type:Organization
Organization Name:TWEEDY DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O
Authorized Official - Prefix:MISS
Authorized Official - First Name:STELLA
Authorized Official - Middle Name:MARISOL
Authorized Official - Last Name:HERRERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-428-8819
Mailing Address - Street 1:4355 TWEEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-6236
Mailing Address - Country:US
Mailing Address - Phone:323-484-9923
Mailing Address - Fax:
Practice Address - Street 1:4355 TWEEDY BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-6236
Practice Address - Country:US
Practice Address - Phone:323-484-9923
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-18
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty