Provider Demographics
NPI:1447071089
Name:TBS DENTAL PLLC
Entity type:Organization
Organization Name:TBS DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER & DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TASNEEM
Authorized Official - Middle Name:BIJLI
Authorized Official - Last Name:SYEDA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:502-882-1243
Mailing Address - Street 1:8153 NEW LA GRANGE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-4680
Mailing Address - Country:US
Mailing Address - Phone:502-882-1243
Mailing Address - Fax:
Practice Address - Street 1:8153 NEW LA GRANGE RD STE 101
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-4680
Practice Address - Country:US
Practice Address - Phone:502-882-1243
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-17
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100898700Medicaid