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General NPI Number Information
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NPI Number | 1760642284
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Entity Type | Organization
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Legal Business Name | IVAN TERRERO DDS PA
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Dates
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Enumeration Date | 06/10/2008
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Last Update Date | 06/10/2008
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Provider Practice Location Address
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Address Line | 15436-7 NW 77TH COURT #150 & 160
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City | MIAMI LAKES
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State | FL
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Zip | 33016
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Country | US
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Telephone | 305-557-5775
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Fax |
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Provider Business Mailing Address
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Address Line | 555 WASHINGTON AVE STE 350
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City | MIAMI
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State | FL
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Zip | 33139-6643
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Country | US
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Telephone | 305-604-5707
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. IVAN EDUARDO TERRERO
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Credential | DDS
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Telephone | 917-796-7624
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN17477
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License Number State | FL
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