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NPI Code Detail

MEDICARE: DR. BRYAN T. TERVO D.D.S.

MEDICARE: DR. BRYAN T. TERVO 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
11223G0001XGeneral Practice DentistryDF0043OR
21223G0001XGeneral Practice Dentistry30.021010OH
31223G0001XGeneral Practice Dentistry019.036514IL
41223G0001XGeneral Practice Dentistry2901601231MI

General Provider Information

NPI Number : 1467563809
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRYAN T. TERVO D.D.S.
Provider Business Mailing Address
First Line : 3204 W CYPRESS CREEK DR
Second Line :
City : DUNLAP
State : IL
Zip : 61525-2514
Country : US
Telephone Number : 971-336-1101
Fax Number :
Provider Business Practice Location Address
First Line : 530 NE GLEN OAK AVE
Second Line :
City : PEORIA
State : IL
Zip : 61637-0001
Country : US
Telephone Number : 309-624-9741
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2006
Last Update Date : 06/17/2026

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