Provider Demographics
NPI:1174653745
Name:DANIEL, TERRY LAWRENCE (DMD,MS)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:LAWRENCE
Last Name:DANIEL
Suffix:
Gender:M
Credentials:DMD,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2784 QUARRY PT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43204-3892
Mailing Address - Country:US
Mailing Address - Phone:614-208-8775
Mailing Address - Fax:
Practice Address - Street 1:170 NORTHWOODS BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-4711
Practice Address - Country:US
Practice Address - Phone:614-888-8585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300222381223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics