Provider Demographics
NPI:1790883494
Name:TENG, JESSE (DDS)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:
Last Name:TENG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5551 N MESA ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-5455
Mailing Address - Country:US
Mailing Address - Phone:915-581-5476
Mailing Address - Fax:915-584-6622
Practice Address - Street 1:5551 N MESA ST
Practice Address - Street 2:SUITE A
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-5455
Practice Address - Country:US
Practice Address - Phone:915-581-5476
Practice Address - Fax:915-584-6622
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX241011223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics