Healthcare Provider Details

I. General information

NPI: 1154804375
Provider Name (Legal Business Name): MICHAEL TERRERY DENTISTRY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2018
Last Update Date: 09/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3180 RTE 611 FOUNTAIN COURT SUITE 14
BARTONSVILLE PA
18321
US

IV. Provider business mailing address

3180 RTE 611 FOUNTAIN COURT SUITE 14
BARTONSVILLE PA
18321
US

V. Phone/Fax

Practice location:
  • Phone: 570-629-1300
  • Fax: 570-629-4300
Mailing address:
  • Phone: 570-629-1300
  • Fax: 570-629-4300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL J TERRERY
Title or Position: PRESIDENT
Credential: DMD
Phone: 570-629-1300