Active NPI
Casey Anne Tenniswood, DDS
- Pediatric Dentistry
- Clifton Park, NY
National Provider Identifier
1164653630
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 054477-1
- Practice address
- 532 Moe Rd
Clifton Park, NY 12065-3822 - Phone
- (518) 373-1181
- Fax
- (518) 348-6517
- NPI assigned
- Aug 1, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 2901019567 | MI | |
| Pediatric Dentistry | 1223P0221X | 054477-1 | NY | Primary |
Addresses
Primary practice location
532 Moe Rd
Clifton Park, NY 12065-3822
Mailing address
532 Moe Rd
Clifton Park, NY 12065-3822
Phone (518) 373-1181
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2901019567 | MI | MD | Dentist |
| 054477-1 | NY | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1249084800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1249084800000",
"number": "1164653630",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "532 MOE RD",
"city": "CLIFTON PARK",
"state": "NY",
"postal_code": "120653822",
"telephone_number": "518-373-1181",
"fax_number": "518-348-6517"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "532 MOE RD",
"city": "CLIFTON PARK",
"state": "NY",
"postal_code": "120653822",
"telephone_number": "518-373-1181",
"fax_number": "518-348-6517"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TENNISWOOD",
"first_name": "CASEY",
"middle_name": "ANNE",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-08-01",
"last_updated": "2009-08-01",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MI",
"license": "2901019567",
"primary": false
},
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "NY",
"license": "054477-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clifton Park, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.