MEDICARE: DR. TERRY L TEST 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	1223G0001X	General Practice Dentistry	D15950	TX

General Provider Information

NPI Number	:	1649288747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERRY L TEST DDS

Provider Business Mailing Address
First Line	:	2900 LONG PRAIRIE RD STE D
Second Line	:
City	:	FLOWER MOUND
State	:	TX
Zip	:	75022-4954
Country	:	US
Telephone Number	:	972-539-6831
Fax Number	:	972-355-5426

Provider Business Practice Location Address
First Line	:	2900 LONG PRAIRIE RD STE D
Second Line	:
City	:	FLOWER MOUND
State	:	TX
Zip	:	75022-4954
Country	:	US
Telephone Number	:	972-539-6831
Fax Number	:	972-355-5426

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

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	07/08/2007

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