Provider Demographics
NPI:1891870291
Name:TENNANT, WILLIAM P (WILLIAM TENNANT)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:P
Last Name:TENNANT
Suffix:
Gender:M
Credentials:WILLIAM TENNANT
Other - Prefix:DR
Other - First Name:WILLIAM
Other - Middle Name:P
Other - Last Name:TENNANT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:2999 REGENT ST
Mailing Address - Street 2:SUITE 714
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2146
Mailing Address - Country:US
Mailing Address - Phone:510-848-3143
Mailing Address - Fax:510-848-2522
Practice Address - Street 1:2999 REGENT ST
Practice Address - Street 2:SUITE 714
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2146
Practice Address - Country:US
Practice Address - Phone:510-848-3143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA232471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA23247OtherDENTAL LISCENSE