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General NPI Number Information
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NPI Number | 1154804375
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Entity Type | Organization
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Legal Business Name | MICHAEL TERRERY DENTISTRY PC
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Dates
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Enumeration Date | 09/13/2018
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Last Update Date | 09/13/2018
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Provider Practice Location Address
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Address Line | 3180 RTE 611 FOUNTAIN COURT SUITE 14
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City | BARTONSVILLE
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State | PA
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Zip | 18321
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Country | US
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Telephone | 570-629-1300
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Fax | 570-629-4300
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Provider Business Mailing Address
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Address Line | 3180 RTE 611 FOUNTAIN COURT SUITE 14
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City | BARTONSVILLE
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State | PA
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Zip | 18321
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Country | US
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Telephone | 570-629-1300
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Fax | 570-629-4300
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL J TERRERY
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Credential | DMD
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Telephone | 570-629-1300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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