Provider Demographics
NPI:1205857745
Name:HALLER, TERRI LYNNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:TERRI
Middle Name:LYNNE
Last Name:HALLER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 CASS ST
Mailing Address - Street 2:SUITE 109
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-2947
Mailing Address - Country:US
Mailing Address - Phone:831-649-8030
Mailing Address - Fax:
Practice Address - Street 1:880 CASS ST
Practice Address - Street 2:SUITE 109
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-2947
Practice Address - Country:US
Practice Address - Phone:831-649-8030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA398051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice