1700888245 NPI number — DR. FRANLILS COMETA TENGASANTOS DDS

Table of content: DR. FRANLILS COMETA TENGASANTOS DDS (NPI 1700888245)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700888245 NPI number — DR. FRANLILS COMETA TENGASANTOS DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TENGASANTOS
Provider First Name:
FRANLILS
Provider Middle Name:
COMETA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700888245
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/04/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 JARRETT WHITE ROAD, BLDG 320 KRUKOWSKI
Provider Second Line Business Mailing Address:
US ARMY DENTAL ACTIVITY HAWAII
Provider Business Mailing Address City Name:
TRIPLER AMC
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96859-5000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-433-1021
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 JARRETT WHITE RD BLDG 320
Provider Second Line Business Practice Location Address:
US ARMY DENTAL ACTIVITY HAWAII
Provider Business Practice Location Address City Name:
TRIPLER AMC
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96859-5001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-433-1021
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  12011 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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