Provider Demographics
NPI:1043229610
Name:TERRIBILINI, PHILIP ALLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:ALLEN
Last Name:TERRIBILINI
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 1:1331 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE G
Mailing Address - City:ROHNERT PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94928-2900
Mailing Address - Country:US
Mailing Address - Phone:707-585-2525
Mailing Address - Fax:707-585-2530
Practice Address - Street 1:1331 MEDICAL CENTER DR
Practice Address - Street 2:SUITE G
Practice Address - City:ROHNERT PARK
Practice Address - State:CA
Practice Address - Zip Code:94928-2900
Practice Address - Country:US
Practice Address - Phone:707-585-2525
Practice Address - Fax:707-585-2530
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA286301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice