Healthcare Provider Details

I. General information

NPI: 1093790495
Provider Name (Legal Business Name): ALFRED JEROME TERP D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2005
Last Update Date: 03/13/2023
Certification Date: 03/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNITED STATES MILITARY ACADEMY 646 SWIFT ROAD, BLDG 606
WEST POINT NY
10996-1942
US

IV. Provider business mailing address

UNITED STATES MILITARY ACADEMY 646 SWIFT ROAD, BLDG 606
WEST POINT NY
10996-1942
US

V. Phone/Fax

Practice location:
  • Phone: 845-938-8265
  • Fax: 845-938-4302
Mailing address:
  • Phone: 845-938-8265
  • Fax: 845-938-4302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDS031480L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: