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1134601669
DERRICK GLEN TENGCO
LAWRENCE, MA
NPI
1134601669
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
122300000X Dentist
(Licence: MA DN1858105)
Enumeration Date
2018-08-31
Last Update Date
2018-08-31
Business Address
DERRICK GLEN TENGCO DMD
314 ESSEX ST
LAWRENCE, MA 01840-1411
Phone number: 605-714-5114
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Mailing Address
DERRICK GLEN TENGCO DMD
1 NASSAU ST APT 909
BOSTON, MA 02111-1554
Phone number: 609-658-3233
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