Provider Demographics
NPI:1326287798
Name:ROZAK, TENNILLE MANRIQUE (DDS)
Entity Type:Individual
Prefix:DR
First Name:TENNILLE
Middle Name:MANRIQUE
Last Name:ROZAK
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 1:10412 DORIS CIR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-4321
Mailing Address - Country:US
Mailing Address - Phone:714-761-4508
Mailing Address - Fax:
Practice Address - Street 1:10412 DORIS CIR
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-4321
Practice Address - Country:US
Practice Address - Phone:714-761-4508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-09
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA574741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice