Individual
JASON TENNY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
10696 SW VILLAGE PKWY, PORT ST LUCIE, FL 34987-2358
(772) 380-4490
Mailing address
10239 SW VILLAGE PKWY APT 206, PORT ST LUCIE, FL 34987-2364
(703) 389-3891
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN 22378
FL
Other
Enumeration date
12/19/2016
Last updated
12/19/2016
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