MEDFORD TLC DENTAL GROUP, LLC (NPI# 1457863953) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1457863953 |
| Entity Type | Organization |
| Organization Name | MEDFORD TLC DENTAL GROUP, LLC |
| Other Organization Name | TLC DENTAL OF MEDFORD |
| Practice Address |
84 High St Ste 5 Medford MA 02155-3844 |
| Practice Telephone | 7813930008 |
| Mailing Telephone | 7813930008 |
| Enumeration Date | 2017-10-25 |
| Last Update Date | 2017-10-26 |
| Authorized Official Name | MRS. ANNA GANOPOLSKY (OWNER) |
| Authorized Official Telephone | 7813930008 |
| Authorized Official Credential | DMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
DN19618 | MA | Dental Providers |
| Other Name | Type Code |
|---|---|
| TLC Dental of Medford | Former Legal Business Name - Organization |
| Street Address |
84 HIGH ST STE 5 |
| City | MEDFORD |
| State | MA |
| Zip Code | 02155-3844 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679613921 | Peter Grossman | Dentist | 84 High St Ste 5, Medford, MA 02155-3844 | 2007-02-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679113922 | Elena Chapman | Nurse Practitioner | 293 Salem St 4, Medford, MA 02155 | 2020-01-14 |
| 1922658830 | Michelle Anne Zona | Counselor | 100 George Hassett Dr, Medford, MA 02155 | 2019-09-13 |
| 1487138509 | Dava Davainis | Social Worker | 76 Newbern Avenue, Apt. 1, Medford, MA 02155 | 2018-09-25 |
| 1265915128 | Erin Roberts | Counselor | Medford Public Schools, 3002 Mystic Valley Pkwy, Medford, MA 02155 | 2018-09-07 |
| 1871075739 | Janice Madeline Cole | Social Worker | 3820 Mystic Valley Pkwy Unit 805, Medford, MA 02155 | 2018-09-06 |
| 1447732573 | Mystick Women's Health, Inc. | Obstetrics & Gynecology | 13 Bradlee Road, Medford, MA 02155 | 2018-09-05 |
| 1144713090 | Laura Rogers | Psychologist | 203 Paige Hall, 12 Upper Campus Road, Medford, MA 02155 | 2018-06-14 |
| 1871086694 | Shuo Yang | Dentist | 8 9th St Apt 310, Medford, MA 02155 | 2018-06-07 |
| 1891287108 | Xuhua Qin | Psychologist | 120 Curtis Street, Medford, MA 02155 | 2018-06-01 |
| 1568953529 | Cvs Pharmacy, Inc. | Durable Medical Equipment & Medical Supplies | 471 Salem St, Medford, MA 02155 | 2018-05-25 |
| Find all providers in zip 02155 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598306490 | Element Family Dental | Dentist | 3860 Mystic Valley Pkwy, Unit B, Medford, MA 02155-5029 | 2019-10-01 |
| 1477119477 | Yu Wang | Dentist | 3620 Mystic Valley Pkwy Apt E209, Medford, MA 02155-5765 | 2019-05-15 |
| 1871086694 | Shuo Yang | Dentist | 8 9th St Apt 310, Medford, MA 02155 | 2018-06-07 |
| 1003320854 | Thompson Dental Associates PC | Dentist | 690 Fellsway, Medford, MA 02155-4901 | 2017-11-30 |
| 1023547536 | Joshua Morgan Rice | Dentist | 1117 E Main St Ste 1, Medford, OR 97504 | 2017-06-08 |
| 1053849943 | Joshua W Doyle | Dentist | 915 Casement Ct, Medford, WI 54451-1204 | 2017-05-23 |
| 1851833131 | Northwest Dental Associates -medford LLC | Dentist | 3551 E Barnett Rd, Suite 101, Medford, OR 97504-7037 | 2016-11-17 |
| 1184074882 | Snoring and Sleep Apnea Care LLC | Dentist | Zero Governors Ave 20-21, Medford, MA 02155-3025 | 2016-06-14 |
| 1487039186 | Benjamin Woolnough | Dentist | 366 Salem Street, Medford, MA 02155 | 2015-07-22 |
| 1275913329 | Trevor Peterson | Dentist | 4411 Brownridge Terrace, Medford, OR 97504 | 2015-06-04 |
| Find all providers in MEDFORD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.