Individual provider Active NPI

Joseph Patrick Tesene, DDS

  • General Practice Dentistry
  • Fort Leonard Wood, MO
National Provider Identifier
1891922167
Registry record updated Jan 31, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
08624 Issued in IA
Practice address
6958 Nebraska Ave
Fort Leonard Wood, MO 65473-1618
Phone
(573) 596-0364
NPI assigned
Jun 15, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 08624 IA Primary

Addresses

Primary practice location

6958 Nebraska Ave
Fort Leonard Wood, MO 65473-1618

Mailing address

6958 Nebraska Ave
Fort Leonard Wood, MO 65473-1618
Phone (573) 596-0364

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
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

Enrollment IDStateProvider typePAC IDDetails
I20160307001294 IA Order and Referring Only - DentistPractitioner - Dentist 5991001604

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Klise Dentistry, PLLC PastSince Dec 12, 2018 Accepting new patients
Stone Ridge Dental PLC General Practice Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1245024000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738281600000",
    "number": "1891922167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6958 NEBRASKA AVE",
            "city": "FORT LEONARD WOOD",
            "state": "MO",
            "postal_code": "654731618",
            "telephone_number": "573-596-0364"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6958 NEBRASKA AVE",
            "city": "FORT LEONARD WOOD",
            "state": "MO",
            "postal_code": "654731618",
            "telephone_number": "573-596-0364"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TESENE",
        "first_name": "JOSEPH",
        "middle_name": "PATRICK",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-15",
        "last_updated": "2025-01-31",
        "certification_date": "2025-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IA",
            "license": "08624",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Leonard Wood, MO

Sources for this page

Verify at the official NPI Registry.