Provider Demographics
NPI:1487605507
Name:TENHOLDER, ANGELA L (DMD)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:L
Last Name:TENHOLDER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 ELEVEN S STE 3F
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:IL
Mailing Address - Zip Code:62236-1077
Mailing Address - Country:US
Mailing Address - Phone:618-281-9729
Mailing Address - Fax:618-281-9734
Practice Address - Street 1:1000 ELEVEN S STE 3F
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:IL
Practice Address - Zip Code:62236-1077
Practice Address - Country:US
Practice Address - Phone:618-281-9729
Practice Address - Fax:618-281-9734
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-13
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-023598122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist