Provider Demographics
NPI:1063604965
Name:TENNEY, JOSEPH DONOVAN (DDS)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:DONOVAN
Last Name:TENNEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 930
Mailing Address - Street 2:100 NORTH 13TH WEST
Mailing Address - City:SAINT JOHNS
Mailing Address - State:AZ
Mailing Address - Zip Code:85936-0930
Mailing Address - Country:US
Mailing Address - Phone:928-337-2522
Mailing Address - Fax:928-337-4881
Practice Address - Street 1:100 NORTH 13TH WEST
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:AZ
Practice Address - Zip Code:85936
Practice Address - Country:US
Practice Address - Phone:928-337-2522
Practice Address - Fax:928-337-4881
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD7350122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZD7350OtherDENTAL STATE LICENSE #