Provider Demographics
NPI:1417026352
Name:TIENABESO, SENIBOYE B (DMD)
Entity Type:Individual
Prefix:DR
First Name:SENIBOYE
Middle Name:B
Last Name:TIENABESO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 KILDARE LANE
Mailing Address - Street 2:
Mailing Address - City:ASTON
Mailing Address - State:PA
Mailing Address - Zip Code:19014-1228
Mailing Address - Country:US
Mailing Address - Phone:484-840-0355
Mailing Address - Fax:215-879-7773
Practice Address - Street 1:7516 CITY LINE AVE
Practice Address - Street 2:SUITE 15
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19151-2102
Practice Address - Country:US
Practice Address - Phone:215-877-3322
Practice Address - Fax:215-879-7773
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS024346L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist