Provider Demographics
NPI:1124014600
Name:BAARSTAD, TERRI LEANNE (DMD)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:LEANNE
Last Name:BAARSTAD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2921 CRESCENT AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97408-7586
Mailing Address - Country:US
Mailing Address - Phone:541-683-8396
Mailing Address - Fax:541-984-1445
Practice Address - Street 1:2921 CRESCENT AVE STE 210
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97408-7586
Practice Address - Country:US
Practice Address - Phone:541-683-8396
Practice Address - Fax:541-984-1445
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD79141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice