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NPI Code Detail

MEDICARE: SUSAN TERRY DDS

MEDICARE: SUSAN TERRY 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
1122300000XDentist0401007279VA

General Provider Information

NPI Number : 1790870871
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN TERRY DDS
Provider Business Mailing Address
First Line : 11846 PERDUE SPRINGS CT
Second Line :
City : CHESTER
State : VA
Zip : 23831-2164
Country : US
Telephone Number : 804-748-4546
Fax Number :
Provider Business Practice Location Address
First Line : 11846 PERDUE SPRINGS CT
Second Line :
City : CHESTER
State : VA
Zip : 23831-2164
Country : US
Telephone Number : 804-748-4546
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2006
Last Update Date : 07/08/2007

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Directions to “ SUSAN TERRY DDS” Practice Location

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