MEDICARE: DR. TERRY JOE PREECE D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	1274	AK
2	1223G0001X	General Practice Dentistry	139712-9922	UT

General Provider Information

NPI Number	:	1447255955
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERRY JOE PREECE D.D.S.

Provider Business Mailing Address
First Line	:	12501 OLD SEWARD HWY
Second Line	:	STE. C
City	:	ANCHORAGE
State	:	AK
Zip	:	99515-3507
Country	:	US
Telephone Number	:	907-222-3242
Fax Number	:	907-222-1454

Provider Business Practice Location Address
First Line	:	12501 OLD SEWARD HWY
Second Line	:	STE. C
City	:	ANCHORAGE
State	:	AK
Zip	:	99515-3507
Country	:	US
Telephone Number	:	907-222-3242
Fax Number	:	907-222-1454

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	09/10/2012

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