Healthcare Provider Details

I. General information

NPI: 1124014600
Provider Name (Legal Business Name): TERRI LEANNE BAARSTAD DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 12/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2921 CRESCENT AVE STE 210
EUGENE OR
97408-7586
US

IV. Provider business mailing address

2921 CRESCENT AVE STE 210
EUGENE OR
97408-7586
US

V. Phone/Fax

Practice location:
  • Phone: 541-683-8396
  • Fax: 541-984-1445
Mailing address:
  • Phone: 541-683-8396
  • Fax: 541-984-1445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD7914
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: