Provider Demographics
NPI:1912263716
Name:TESSENDORF, ERIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:
Last Name:TESSENDORF
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 1:905 LOCH WOOD CT
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54703-2093
Mailing Address - Country:US
Mailing Address - Phone:708-921-5027
Mailing Address - Fax:
Practice Address - Street 1:38 E GRAND AVE
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-2524
Practice Address - Country:US
Practice Address - Phone:715-723-6800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-05
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6897-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist