Provider Demographics
NPI:1932299179
Name:TENCZA, MICHAEL G (DDS PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:G
Last Name:TENCZA
Suffix:
Gender:M
Credentials:DDS PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 FOUNTAINHEAD LANE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301
Mailing Address - Country:US
Mailing Address - Phone:910-433-3612
Mailing Address - Fax:910-433-3659
Practice Address - Street 1:227 FOUNTAINHEAD LANE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301
Practice Address - Country:US
Practice Address - Phone:910-433-3612
Practice Address - Fax:910-433-3659
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6096122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5911987Medicaid
NCW1341590601OtherNC HEALTH CHOICE
6096OtherDELTA DENTAL
NC903H5OtherBC/BS