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Individual

DERRICK GLEN TENGCO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DMD

Contact information

Practice address
314 ESSEX ST, LAWRENCE, MA 01840-1411
(605) 714-5114
Mailing address
1 NASSAU ST APT 909, BOSTON, MA 02111-1554
(609) 658-3233

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN1858105
MA

Other

Enumeration date
08/31/2018
Last updated
08/31/2018
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