Provider Demographics
NPI:1659728947
Name:TENDRIH, DAFNA (DMD)
Entity Type:Individual
Prefix:
First Name:DAFNA
Middle Name:
Last Name:TENDRIH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:DAFNA
Other - Middle Name:
Other - Last Name:MILSZTAJN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:194 RUTH ANN WAY
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-2459
Mailing Address - Country:US
Mailing Address - Phone:917-238-2618
Mailing Address - Fax:
Practice Address - Street 1:194 RUTH ANN WAY
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-2459
Practice Address - Country:US
Practice Address - Phone:917-238-2618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-17
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100566122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist