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General NPI Number Information
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NPI Number | 1316271638
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Entity Type | Individual
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Provider Name | CASEY TERRY
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Gender | Female
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Dates
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Enumeration Date | 09/21/2009
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Last Update Date | 09/21/2009
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Provider Practice Location Address
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Address Line | 162 SHARP AND PERKINS RD
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City | JACKSBORO
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State | TN
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Zip | 37757-2507
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Country | US
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Telephone | 423-562-8351
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Fax | 423-562-1593
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Provider Business Mailing Address
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Address Line | 162 SHARP AND PERKINS RD P.O. BOX 418
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City | JACKSBORO
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State | TN
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Zip | 37757-2507
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Country | US
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Telephone | 423-562-8351
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Fax | 423-562-1593
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 126800000X
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Taxonomy Name | Dental Assistant
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License Number | DA0000010658
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License Number State | TN
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