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General NPI Number Information
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NPI Number | 1417026352
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Entity Type | Individual
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Provider Name | SENIBOYE B. TIENABESO D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/07/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 7516 CITY LINE AVE SUITE 15
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City | PHILADELPHIA
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State | PA
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Zip | 19151-2102
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Country | US
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Telephone | 215-877-3322
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Fax | 215-879-7773
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Provider Business Mailing Address
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Address Line | 104 KILDARE LANE
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City | ASTON
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State | PA
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Zip | 19014-1228
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Country | US
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Telephone | 484-840-0355
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Fax | 215-879-7773
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | DS024346L
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License Number State | PA
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