Active NPI
Angela L Tenholder, D.M.D.
- Dentist
- Columbia, IL
National Provider Identifier
1487605507
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 019-023598
- Practice address
- 1000 Eleven S Ste 3F
Columbia, IL 62236-1077 - Phone
- (618) 281-9729
- Fax
- (618) 281-9734
- NPI assigned
- May 13, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 019-023598 | IL | Primary |
Addresses
Primary practice location
1000 Eleven S Ste 3F
Columbia, IL 62236-1077
Mailing address
1000 Eleven S Ste 3F
Columbia, IL 62236-1077
Phone (618) 281-9729
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Apr 16, 2019 through Apr 16, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019-023598 | IL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147478400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1578441600000",
"number": "1487605507",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1000 ELEVEN S STE 3F",
"city": "COLUMBIA",
"state": "IL",
"postal_code": "622361077",
"telephone_number": "618-281-9729",
"fax_number": "618-281-9734"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 ELEVEN S STE 3F",
"city": "COLUMBIA",
"state": "IL",
"postal_code": "622361077",
"telephone_number": "618-281-9729",
"fax_number": "618-281-9734"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TENHOLDER",
"first_name": "ANGELA",
"middle_name": "L",
"credential": "D.M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-05-13",
"last_updated": "2020-01-08",
"certification_date": "2020-01-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "019-023598",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Columbia, IL
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- Patricia Swanson, LCSW
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- Kaila Renee Taylor
- Melody Ann Terry, FNP
- The Hearing Hub, LLC
- Andrea Nicole Thomas, PAC
- Tiny Voices Therapy PC
- Total Body Renewal Medical Weight Management & Laser Treatment Cente
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2020; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.