Provider Demographics
NPI:1033163886
Name:PHILIBIN, TERRY B (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:B
Last Name:PHILIBIN
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 NILES CORTLAND RD SE
Mailing Address - Street 2:SUITE #101
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-2460
Mailing Address - Country:US
Mailing Address - Phone:330-856-7111
Mailing Address - Fax:330-856-7007
Practice Address - Street 1:405 NILES CORTLAND RD SE
Practice Address - Street 2:SUITE #101
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-2460
Practice Address - Country:US
Practice Address - Phone:330-856-7111
Practice Address - Fax:330-856-7007
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-01-94431223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHU57584Medicare UPIN
OHTE0788822Medicare ID - Type Unspecified