Provider Demographics
NPI:1114195369
Name:GOULD, TERRY L (DDS)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:L
Last Name:GOULD
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 1:100 CROIX STREET
Mailing Address - Street 2:
Mailing Address - City:NEGAUNEE
Mailing Address - State:MI
Mailing Address - Zip Code:49866-1104
Mailing Address - Country:US
Mailing Address - Phone:906-475-9958
Mailing Address - Fax:906-475-5146
Practice Address - Street 1:100 CROIX STREET
Practice Address - Street 2:
Practice Address - City:NEGAUNEE
Practice Address - State:MI
Practice Address - Zip Code:49866-1104
Practice Address - Country:US
Practice Address - Phone:906-475-9958
Practice Address - Fax:906-475-5146
Is Sole Proprietor?:No
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010113001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice