Provider Demographics
NPI:1003904053
Name:DEAN, TERRENCE BARTHOLOMEW (DDS)
Entity Type:Individual
Prefix:DR
First Name:TERRENCE
Middle Name:BARTHOLOMEW
Last Name:DEAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 SHERIDAN ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-3749
Mailing Address - Country:US
Mailing Address - Phone:570-322-8358
Mailing Address - Fax:
Practice Address - Street 1:1201 SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-3749
Practice Address - Country:US
Practice Address - Phone:570-322-8358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPA019526L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice