MEDICARE: DR. IVAN E TERRERO DDS

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	122300000X	Dentist	043274	NY
2	122300000X	Dentist	DN17477	FL

General Provider Information

NPI Number	:	1720066673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IVAN E TERRERO DDS

Provider Business Mailing Address
First Line	:	26800 S TAMIAMI TRL
Second Line	:	SUITE 350
City	:	BONITA SPRINGS
State	:	FL
Zip	:	34134-4349
Country	:	US
Telephone Number	:	239-676-9696
Fax Number	:	239-221-7161

Provider Business Practice Location Address
First Line	:	26800 S TAMIAMI TRL
Second Line	:	SUITE 350
City	:	BONITA SPRINGS
State	:	FL
Zip	:	34134-4349
Country	:	US
Telephone Number	:	239-676-9696
Fax Number	:	239-221-7161

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

Provider Enumeration Date	:	01/01/2006
Last Update Date	:	04/27/2009

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