MEDICARE: DR. TENILLE N PHANG D.D.S.

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	122300000X	Dentist	DN24517	FL

General Provider Information

NPI Number	:	1427291830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TENILLE N PHANG D.D.S.

Provider Business Mailing Address
First Line	:	2444 E SEMORAN BLVD
Second Line	:
City	:	APOPKA
State	:	FL
Zip	:	32703-5805
Country	:	US
Telephone Number	:	516-884-8590
Fax Number	:

Provider Business Practice Location Address
First Line	:	2444 E SEMORAN BLVD
Second Line	:
City	:	APOPKA
State	:	FL
Zip	:	32703-5805
Country	:	US
Telephone Number	:	407-410-6848
Fax Number	:	407-775-2561

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

Provider Enumeration Date	:	04/14/2009
Last Update Date	:	03/28/2022

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