Provider Demographics
NPI:1326764325
Name:STREETER, TESSA (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:TESSA
Middle Name:
Last Name:STREETER
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3828 TIMBERLINE WAY
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35243-2452
Mailing Address - Country:US
Mailing Address - Phone:407-697-1076
Mailing Address - Fax:
Practice Address - Street 1:1705 VESTAVIA PKWY
Practice Address - Street 2:
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35216-3752
Practice Address - Country:US
Practice Address - Phone:205-979-7072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALCS-00070041223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics