Provider Demographics
NPI:1023481546
Name:THOMAS TENNEY DMD, LTD.
Entity type:Organization
Organization Name:THOMAS TENNEY DMD, LTD.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:TENNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:469-830-7525
Mailing Address - Street 1:765 CROSS TIMBERS RD. #105
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-1392
Mailing Address - Country:US
Mailing Address - Phone:469-830-7525
Mailing Address - Fax:469-830-7524
Practice Address - Street 1:765 CROSS TIMBERS RD. #105
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-1392
Practice Address - Country:US
Practice Address - Phone:469-830-7525
Practice Address - Fax:469-830-7524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-05
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV32201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX26551Medicaid