MEDICARE: KRISTIANA MARIE TENORIO DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	37612	TX

General Provider Information

NPI Number	:	1225601735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIANA MARIE TENORIO DDS

Provider Business Mailing Address
First Line	:	4004 S BRAESWOOD BLVD STE 300
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77025-3304
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4004 S BRAESWOOD BLVD STE 300
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77025-3304
Country	:	US
Telephone Number	:	346-509-9099
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2021
Last Update Date	:	05/02/2023

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