Provider Demographics
NPI:1114286176
Name:CARDINAL, TERRY (RDH)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:
Last Name:CARDINAL
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:TERRY
Other - Middle Name:
Other - Last Name:LANDECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:40 MANSFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:WILLIMANTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06226-2018
Mailing Address - Country:US
Mailing Address - Phone:860-450-7471
Mailing Address - Fax:860-450-9808
Practice Address - Street 1:40 MANSFIELD AVE
Practice Address - Street 2:
Practice Address - City:WILLIMANTIC
Practice Address - State:CT
Practice Address - Zip Code:06226-2018
Practice Address - Country:US
Practice Address - Phone:860-450-7471
Practice Address - Fax:860-450-9808
Is Sole Proprietor?:No
Enumeration Date:2012-05-11
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6894124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist