Provider Demographics
NPI:1114225661
Name:TERRY, MARK ALLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALLEN
Last Name:TERRY
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 1:2800 JACKSON BLVD STE 6
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-3477
Mailing Address - Country:US
Mailing Address - Phone:605-348-2556
Mailing Address - Fax:605-348-1526
Practice Address - Street 1:2800 JACKSON BLVD STE 6
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-3477
Practice Address - Country:US
Practice Address - Phone:605-348-2556
Practice Address - Fax:605-348-1526
Is Sole Proprietor?:No
Enumeration Date:2011-03-08
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDD10141223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics