Healthcare Provider Details

I. General information

NPI: 1790870012
Provider Name (Legal Business Name): TERRI L. BAARSTAD, DMD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1045 WILLAGILLESPIE RD STE 250
EUGENE OR
97401-6724
US

IV. Provider business mailing address

1045 WILLAGILLESPIE RD STE 250
EUGENE OR
97401-6724
US

V. Phone/Fax

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

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: DR. TERRI LEANNE BAARSTAD
Title or Position: PRESIDENT CORPORATION
Credential: DMD
Phone: 541-683-8396