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General NPI Number Information
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NPI Number | 1891992483
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Entity Type | Individual
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Provider Name | JOHN NOLAN TESSENDORF DDS
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Gender | Male
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Dates
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Enumeration Date | 06/28/2007
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Last Update Date | 06/15/2015
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Provider Practice Location Address
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Address Line | 215 5TH AVE
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City | EAU CLAIRE
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State | WI
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Zip | 54703-5698
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Country | US
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Telephone | 715-832-3100
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Fax | 715-832-3170
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Provider Business Mailing Address
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Address Line | 215 5TH AVE
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City | EAU CLAIRE
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State | WI
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Zip | 54703-5698
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Country | US
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Telephone | 715-832-3100
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Fax | 715-832-3170
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2245
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License Number State | WI
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