Provider Demographics
NPI:1871672055
Name:TENO, JEFFREY RICHARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:RICHARD
Last Name:TENO
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 1:16800 24 MILE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48042
Mailing Address - Country:US
Mailing Address - Phone:586-781-2757
Mailing Address - Fax:586-781-5493
Practice Address - Street 1:16800 24 MILE
Practice Address - Street 2:SUITE 5
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48042
Practice Address - Country:US
Practice Address - Phone:586-781-2757
Practice Address - Fax:586-781-5493
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI13318122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist