Provider Demographics
NPI:1245636034
Name:S TENGGREN DENTAL CORP
Entity type:Organization
Organization Name:S TENGGREN DENTAL CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-306-0200
Mailing Address - Street 1:2796 SYCAMORE DR
Mailing Address - Street 2:STE 200
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-1546
Mailing Address - Country:US
Mailing Address - Phone:805-306-0200
Mailing Address - Fax:805-306-0221
Practice Address - Street 1:2796 SYCAMORE DR
Practice Address - Street 2:STE 200
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-1546
Practice Address - Country:US
Practice Address - Phone:805-306-0200
Practice Address - Fax:805-306-0221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-06
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty