Provider Demographics
NPI:1063775377
Name:TENOR FAMILY DENTISTRY OF APPLETON
Entity type:Organization
Organization Name:TENOR FAMILY DENTISTRY OF APPLETON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BERGENE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-860-9252
Mailing Address - Street 1:850 ELM GROVE RD STE 25
Mailing Address - Street 2:
Mailing Address - City:ELM GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53122-2527
Mailing Address - Country:US
Mailing Address - Phone:920-860-9252
Mailing Address - Fax:
Practice Address - Street 1:2600 N RICHMOND ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-1956
Practice Address - Country:US
Practice Address - Phone:920-730-0400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-21
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty