Provider Demographics
NPI:1578595914
Name:TESENE, ROY A (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:A
Last Name:TESENE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 STATE ST
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:IA
Mailing Address - Zip Code:50438-1108
Mailing Address - Country:US
Mailing Address - Phone:641-923-3771
Mailing Address - Fax:641-923-2630
Practice Address - Street 1:55 STATE ST
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:IA
Practice Address - Zip Code:50438-1108
Practice Address - Country:US
Practice Address - Phone:641-923-3771
Practice Address - Fax:641-923-2630
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA064691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0162859Medicaid
IA06469OtherIOWA DENTAL LISCENS NUMBE