Healthcare Provider Details

I. General information

NPI: 1275636409
Provider Name (Legal Business Name): TERENCE R ZIEHMER DDS MSD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1739 W AJO WAY
TUCSON AZ
85713
US

IV. Provider business mailing address

706 E BELL RD STE 104
PHOENIX AZ
85022
US

V. Phone/Fax

Practice location:
  • Phone: 520-206-0030
  • Fax: 520-889-0750
Mailing address:
  • Phone: 602-482-7000
  • Fax: 602-482-7021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number6778
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: