Healthcare Provider Details

I. General information

NPI: 1437111721
Provider Name (Legal Business Name): RONALD B. TERRY DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 12/09/2021
Certification Date: 12/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BLDG 38717, 38TH ST USA DENTAC
FT GORDON GA
30905-5660
US

IV. Provider business mailing address

2340 LEGACY CIR STE 2
ELIZABETH CO
80107-8302
US

V. Phone/Fax

Practice location:
  • Phone: 706-787-6927
  • Fax: 706-787-2082
Mailing address:
  • Phone: 303-646-6336
  • Fax: 303-646-5355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number10143
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: