Provider Demographics
NPI:1942775457
Name:NATHAN P TENNEY DMD, PLLC
Entity Type:Organization
Organization Name:NATHAN P TENNEY DMD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:PALMER
Authorized Official - Last Name:TENNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:602-978-1790
Mailing Address - Street 1:18275 N 59TH AVE # C-114
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-1260
Mailing Address - Country:US
Mailing Address - Phone:602-978-1790
Mailing Address - Fax:
Practice Address - Street 1:18275 N 59TH AVE # C-114
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-1260
Practice Address - Country:US
Practice Address - Phone:602-978-1790
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-11
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental