Provider Demographics
NPI:1912966201
Name:TEJERA, TINERFE J (MD, DMD)
Entity type:Individual
Prefix:DR
First Name:TINERFE
Middle Name:J
Last Name:TEJERA
Suffix:
Gender:M
Credentials:MD, DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8267 COLLEGE PARKWAY
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919
Mailing Address - Country:US
Mailing Address - Phone:239-936-8151
Mailing Address - Fax:239-936-1139
Practice Address - Street 1:8267 COLLEGE PKWY
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-5193
Practice Address - Country:US
Practice Address - Phone:239-936-8151
Practice Address - Fax:239-936-1139
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN163011223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL40442Medicare ID - Type UnspecifiedGROUP NUMBER
FL78841ZMedicare ID - Type Unspecified
FLH22780Medicare UPIN