Provider Demographics
NPI:1295909802
Name:TENNANT, ALFRED J (DDS)
Entity type:Individual
Prefix:MR
First Name:ALFRED
Middle Name:J
Last Name:TENNANT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 N ARMENIA AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6451
Mailing Address - Country:US
Mailing Address - Phone:813-870-6000
Mailing Address - Fax:
Practice Address - Street 1:4200 N ARMENIA AVE STE 3
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6451
Practice Address - Country:US
Practice Address - Phone:813-870-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-15
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN136411223G0001X
LA45171223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Yes1223G0001XDental ProvidersDentistGeneral Practice