Eddie Glenn Tennison, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

14580 Issued in TX

Practice address

2117 N Mays St
Round Rock, TX 78664-2155

Phone

(512) 244-1221

Fax

(512) 244-7773

NPI assigned

May 11, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727049600000",
    "number": "1023068038",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2021 N MAYS ST STE 1200",
            "city": "ROUND ROCK",
            "state": "TX",
            "postal_code": "786642170",
            "telephone_number": "512-244-1221",
            "fax_number": "512-244-7773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2117 N MAYS ST",
            "city": "ROUND ROCK",
            "state": "TX",
            "postal_code": "786642155",
            "telephone_number": "512-244-1221",
            "fax_number": "512-244-7773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TENNISON",
        "first_name": "EDDIE",
        "middle_name": "GLENN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-11",
        "last_updated": "2024-09-23",
        "certification_date": "2024-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "14580",
            "primary": true
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "TX",
            "license": "14580",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110975302",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tejas Next Health
• Luisa Tellez, BCBA
• Temple Choice Dental
• Tendercare Pedi Supply
• Lindsay Erin Tennis
• Teravista Family Wellness, PLLC
• Terry C Chambless M.D.,P.a.
• Jasmine Cordieh Tetley, DO
• Texan Eye, P.a.
• Texas a&M University System Health Science Center

• General Practice Dentistry in Round Rock, TX
• Providers in Round Rock, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.