Provider Demographics
NPI:1326143496
Name:DAVIDSON, TERRY L (DDS)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:L
Last Name:DAVIDSON
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 1:120 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-2155
Mailing Address - Country:US
Mailing Address - Phone:316-283-0110
Mailing Address - Fax:316-283-0736
Practice Address - Street 1:120 W 6TH ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114-2155
Practice Address - Country:US
Practice Address - Phone:316-283-0110
Practice Address - Fax:316-283-0736
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS56351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice