Healthcare Provider Details

I. General information

NPI: 1447609490
Provider Name (Legal Business Name): ALYSSA TENNEY D.D.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2016
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5480 BIG TYLER RD
CROSS LANES WV
25313-1116
US

IV. Provider business mailing address

5480 BIG TYLER RD
CROSS LANES WV
25313-1116
US

V. Phone/Fax

Practice location:
  • Phone: 304-776-1212
  • Fax: 304-776-4542
Mailing address:
  • Phone: 304-776-1212
  • Fax: 304-776-4542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4220
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: