Provider Demographics
NPI:1629803549
Name:TOYA, TENISE (RDH)
Entity type:Individual
Prefix:
First Name:TENISE
Middle Name:
Last Name:TOYA
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 SHEEP SPRINGS WAY
Mailing Address - Street 2:
Mailing Address - City:JEMEZ PUEBLO
Mailing Address - State:NM
Mailing Address - Zip Code:87024
Mailing Address - Country:US
Mailing Address - Phone:575-834-7388
Mailing Address - Fax:
Practice Address - Street 1:110 SHEEP SPRINGS WAY
Practice Address - Street 2:
Practice Address - City:JEMEZ PUEBLO
Practice Address - State:NM
Practice Address - Zip Code:87024
Practice Address - Country:US
Practice Address - Phone:575-834-7388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-03
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDH3861124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist