Provider Demographics
NPI:1063746741
Name:TENN, LESLEY OLIVIA (DMD)
Entity type:Individual
Prefix:DR
First Name:LESLEY
Middle Name:OLIVIA
Last Name:TENN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1242 NW 141ST AVE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-2367
Mailing Address - Country:US
Mailing Address - Phone:954-801-0125
Mailing Address - Fax:954-433-8218
Practice Address - Street 1:1242 NW 141ST AVE
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-2367
Practice Address - Country:US
Practice Address - Phone:954-801-0125
Practice Address - Fax:954-433-8218
Is Sole Proprietor?:No
Enumeration Date:2009-09-28
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN186001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice