Healthcare Provider Details

I. General information

NPI: 1396067575
Provider Name (Legal Business Name): TERRY L. SCHRUBB DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2010
Last Update Date: 02/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 NASHUA RD
DRACUT MA
01826-1955
US

IV. Provider business mailing address

505 NASHUA RD
DRACUT MA
01826-1955
US

V. Phone/Fax

Practice location:
  • Phone: 978-957-5733
  • Fax: 978-957-1830
Mailing address:
  • Phone: 978-957-5733
  • Fax: 978-957-1830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number State

VIII. Authorized Official

Name: JAYSHREE SCHRUBB
Title or Position: ACCOUNTING SPECIALIST
Credential:
Phone: 978-957-5733