Healthcare Provider Details

I. General information

NPI: 1245121078
Provider Name (Legal Business Name): CARLOS EDUARDO TERRES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2025
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 MARTIN LUTHER KING JR BLVD
DETROIT MI
48208-2576
US

IV. Provider business mailing address

2700 MARTIN LUTHER KING JR BLVD
DETROIT MI
48208-2576
US

V. Phone/Fax

Practice location:
  • Phone: 313-494-6651
  • Fax:
Mailing address:
  • Phone: 313-494-6651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberS-1122
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number2901602628
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: