Provider Demographics
NPI:1467067009
Name:TEBO, DENIS
Entity Type:Individual
Prefix:
First Name:DENIS
Middle Name:
Last Name:TEBO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6903 GOOD LUCK RD
Mailing Address - Street 2:
Mailing Address - City:NEW CARROLLTON
Mailing Address - State:MD
Mailing Address - Zip Code:20784-3620
Mailing Address - Country:US
Mailing Address - Phone:240-413-1393
Mailing Address - Fax:
Practice Address - Street 1:6903 GOOD LUCK RD
Practice Address - Street 2:
Practice Address - City:NEW CARROLLTON
Practice Address - State:MD
Practice Address - Zip Code:20784-3620
Practice Address - Country:US
Practice Address - Phone:240-413-1393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC276987399Medicaid