Provider Demographics
NPI:1427291830
Name:PHANG, TENILLE N (DDS)
Entity type:Individual
Prefix:DR
First Name:TENILLE
Middle Name:N
Last Name:PHANG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2444 E SEMORAN BLVD
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-5805
Mailing Address - Country:US
Mailing Address - Phone:516-884-8590
Mailing Address - Fax:
Practice Address - Street 1:2444 E SEMORAN BLVD
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-5805
Practice Address - Country:US
Practice Address - Phone:407-410-6848
Practice Address - Fax:407-775-2561
Is Sole Proprietor?:No
Enumeration Date:2009-04-14
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN24517122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist