Provider Demographics
NPI:1851541031
Name:TENGONCIANG, ALAN JAYSON (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:JAYSON
Last Name:TENGONCIANG
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 1:3737 MORAGA AVE STE B313
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-5481
Mailing Address - Country:US
Mailing Address - Phone:858-270-2760
Mailing Address - Fax:
Practice Address - Street 1:3737 MORAGA AVE STE B313
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-5481
Practice Address - Country:US
Practice Address - Phone:858-270-2760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-24
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA614801223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty