MEDICARE: DR. TERRY M WILWERDING DDS

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	4563	NE

General Provider Information

NPI Number	:	1396728945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERRY M WILWERDING DDS

Provider Business Mailing Address
First Line	:	5032 UNDERWOOD AVE
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68132-2236
Country	:	US
Telephone Number	:	402-558-9255
Fax Number	:

Provider Business Practice Location Address
First Line	:	5032 UNDERWOOD AVE
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68132-2236
Country	:	US
Telephone Number	:	402-558-9255
Fax Number	:

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

Provider Enumeration Date	:	11/28/2005
Last Update Date	:	07/08/2007

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