Individual
DR. EDDIE GLENN TENNISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
2117 N MAYS ST, ROUND ROCK, TX 78664-2155
(512) 244-1221
(512) 244-7773
Mailing address
2021 N MAYS ST STE 1200, ROUND ROCK, TX 78664-2170
(512) 244-1221
(512) 244-7773
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
14580
TX
1223P0221X
Pediatric Dentistry
14580
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110975302
—
TX
Enumeration date
05/11/2006
Last updated
09/23/2024
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