Provider Demographics
NPI:1164619318
Name:TENNEY, JODI PEIPER (DDS)
Entity Type:Individual
Prefix:DR
First Name:JODI
Middle Name:PEIPER
Last Name:TENNEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 CRABAPPLE WAY
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-6723
Mailing Address - Country:US
Mailing Address - Phone:972-540-7601
Mailing Address - Fax:
Practice Address - Street 1:708 CRABAPPLE WAY
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-6723
Practice Address - Country:US
Practice Address - Phone:972-540-7601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-02
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19522122300000X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
19522OtherTX LICENSE NUMBER