Provider Demographics
NPI:1043308026
Name:COLQUITT, TERRI COOPER (DDS MSD)
Entity Type:Individual
Prefix:DR
First Name:TERRI
Middle Name:COOPER
Last Name:COLQUITT
Suffix:
Gender:F
Credentials:DDS MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 D.B. TODD, M.D. BLVD
Mailing Address - Street 2:MEHARRY MEDICAL COLLEGE SOD DEPT OF PERIODONTICS
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204
Mailing Address - Country:US
Mailing Address - Phone:615-327-6300
Mailing Address - Fax:
Practice Address - Street 1:1005 DR. D.B. TODD,JR. BLVD
Practice Address - Street 2:MEHARRY MEDICAL COLLEGE SOD DEPT OF PERIODONTICS
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37208-3501
Practice Address - Country:US
Practice Address - Phone:615-327-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5385122300000X
AL50331223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009932145Medicaid
96964Medicare UPIN
AL051554208Medicare ID - Type Unspecified