Provider Demographics
NPI:1205918687
Name:TENAGLIA, CHRISTINE A (DDS)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:A
Last Name:TENAGLIA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3985 OKEMOS RD
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-3637
Mailing Address - Country:US
Mailing Address - Phone:517-347-6733
Mailing Address - Fax:517-347-7980
Practice Address - Street 1:3985 OKEMOS RD
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-3637
Practice Address - Country:US
Practice Address - Phone:517-347-6733
Practice Address - Fax:517-347-7980
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI160931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice