MEDICARE: DR. TERRY R DEAN D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	6440	KY

General Provider Information

NPI Number	:	1134460769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERRY R DEAN D.M.D.

Provider Business Mailing Address
First Line	:	1906 COLLEGE HEIGHTS BLVD
Second Line	:	WESTERN KENTUCKY UNIVERSITY
City	:	BOWLING GREEN
State	:	KY
Zip	:	42101-1000
Country	:	US
Telephone Number	:	270-745-2426
Fax Number	:	270-745-6869

Provider Business Practice Location Address
First Line	:	1906 COLLEGE HEIGHTS BLVD
Second Line	:	WESTERN KENTUCKY UNIVERSITY
City	:	BOWLING GREEN
State	:	KY
Zip	:	42101-1000
Country	:	US
Telephone Number	:	270-745-2426
Fax Number	:	270-745-6869

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2013
Last Update Date	:	03/06/2013

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