Provider Demographics
NPI:1124223789
Name:BROWN, TERRY RUNDELL RYGAARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:RUNDELL RYGAARD
Last Name:BROWN
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:BOX 907
Mailing Address - Street 2:
Mailing Address - City:TELLURIDE
Mailing Address - State:CO
Mailing Address - Zip Code:81435
Mailing Address - Country:US
Mailing Address - Phone:970-728-3665
Mailing Address - Fax:970-728-6589
Practice Address - Street 1:101 E COLORADO
Practice Address - Street 2:#202
Practice Address - City:TELLURIDE
Practice Address - State:CO
Practice Address - Zip Code:81435
Practice Address - Country:US
Practice Address - Phone:970-728-3665
Practice Address - Fax:970-728-6589
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00479122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist