Provider Demographics
NPI:1184841975
Name:FANGMAN, TERRANCE L (DDS)
Entity Type:Individual
Prefix:
First Name:TERRANCE
Middle Name:L
Last Name:FANGMAN
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 1:8761 W CENTER RD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-2109
Mailing Address - Country:US
Mailing Address - Phone:402-393-5857
Mailing Address - Fax:402-393-8733
Practice Address - Street 1:8761 W CENTER RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-2109
Practice Address - Country:US
Practice Address - Phone:402-393-5857
Practice Address - Fax:402-393-8733
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE35861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice