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General NPI Number Information
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NPI Number | 1063775377
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Entity Type | Organization
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Legal Business Name | TENOR FAMILY DENTISTRY OF APPLETON
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Dates
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Enumeration Date | 06/21/2012
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Last Update Date | 06/21/2012
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Provider Practice Location Address
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Address Line | 2600 N RICHMOND ST
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City | APPLETON
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State | WI
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Zip | 54911-1956
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Country | US
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Telephone | 920-730-0400
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Fax |
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Provider Business Mailing Address
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Address Line | 850 ELM GROVE RD STE 25
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City | ELM GROVE
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State | WI
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Zip | 53122-2527
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Country | US
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Telephone | 920-860-9252
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | REBECCA LYNN BERGENE
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Credential |
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Telephone | 920-860-9252
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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