Provider Demographics
NPI:1912275314
Name:SYNERGY THERAPEUTICS, PC
Entity Type:Organization
Organization Name:SYNERGY THERAPEUTICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:L
Authorized Official - Last Name:TENHOLDER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:618-281-9729
Mailing Address - Street 1:1000 ELEVEN SOUTH
Mailing Address - Street 2:SUITE 3F
Mailing Address - City:COLUMBIA
Mailing Address - State:IL
Mailing Address - Zip Code:62236
Mailing Address - Country:US
Mailing Address - Phone:618-281-9729
Mailing Address - Fax:618-281-9734
Practice Address - Street 1:1000 ELEVEN SOUTH
Practice Address - Street 2:SUITE 3F
Practice Address - City:COLUMBIA
Practice Address - State:IL
Practice Address - Zip Code:62236
Practice Address - Country:US
Practice Address - Phone:618-281-9729
Practice Address - Fax:618-281-9734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-13
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL060010668122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty