Provider Demographics
NPI:1487603635
Name:TENDLER, ALFREDO E (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:ALFREDO
Middle Name:E
Last Name:TENDLER
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17901NW5TH ST 101
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-2810
Mailing Address - Country:US
Mailing Address - Phone:954-437-2222
Mailing Address - Fax:954-437-2244
Practice Address - Street 1:17901 NW 5TH ST STE 101
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-2810
Practice Address - Country:US
Practice Address - Phone:954-437-2222
Practice Address - Fax:954-437-2244
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN-168581223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59-2043705OtherTAX ID
FL21328CMedicare PIN
FL21328BMedicare PIN
FL59-2043705OtherTAX ID
FL21328Medicare PIN