Provider Demographics
NPI:1134460769
Name:DEAN, TERRY R (DMD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:R
Last Name:DEAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1906 COLLEGE HEIGHTS BLVD
Mailing Address - Street 2:WESTERN KENTUCKY UNIVERSITY
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-1000
Mailing Address - Country:US
Mailing Address - Phone:270-745-2426
Mailing Address - Fax:270-745-6869
Practice Address - Street 1:1906 COLLEGE HEIGHTS BLVD
Practice Address - Street 2:WESTERN KENTUCKY UNIVERSITY
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-1000
Practice Address - Country:US
Practice Address - Phone:270-745-2426
Practice Address - Fax:270-745-6869
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-06
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6440122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist