Provider Demographics
NPI:1285443705
Name:TLC DENTAL, PLLC
Entity type:Organization
Organization Name:TLC DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PEDIATRIC DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:CRANDALL
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-593-7998
Mailing Address - Street 1:4701 183A TOLL RD STE A400
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-0123
Mailing Address - Country:US
Mailing Address - Phone:512-593-7998
Mailing Address - Fax:512-717-3396
Practice Address - Street 1:4701 183A TOLL RD STE A400
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-0123
Practice Address - Country:US
Practice Address - Phone:512-593-7998
Practice Address - Fax:512-717-3396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-31
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty