=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861695942
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | I. E. TERRERO, DENTIST P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/07/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1100 2ND AVE
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10022-2029
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-214-0500
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1100 2ND AVE
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10022-2029
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-214-0500
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | IVAN EDUARDO TERRERO
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 646-214-0500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 043274
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------