MEDICARE: DR. TERRY LYLE DRESSELL DMD

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	1223G0001X	General Practice Dentistry	4925	OR

General Provider Information

NPI Number	:	1457352130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERRY LYLE DRESSELL DMD

Provider Business Mailing Address
First Line	:	5350 HOMEDALE RD
Second Line	:
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97603-8437
Country	:	US
Telephone Number	:	541-884-0447
Fax Number	:	541-882-6961

Provider Business Practice Location Address
First Line	:	5350 HOMEDALE RD
Second Line	:
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97603-8437
Country	:	US
Telephone Number	:	541-884-0447
Fax Number	:	541-882-6961

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

Provider Enumeration Date	:	08/03/2005
Last Update Date	:	07/08/2007

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