Provider Demographics
NPI:1346664141
Name:SEDILLO, TERYN (DDS)
Entity Type:Individual
Prefix:
First Name:TERYN
Middle Name:
Last Name:SEDILLO
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 1:5884 HIGH PASTURE DR
Mailing Address - Street 2:
Mailing Address - City:FORT CALHOUN
Mailing Address - State:NE
Mailing Address - Zip Code:68023-8201
Mailing Address - Country:US
Mailing Address - Phone:913-704-8012
Mailing Address - Fax:
Practice Address - Street 1:5884 HIGH PASTURE DR
Practice Address - Street 2:
Practice Address - City:FORT CALHOUN
Practice Address - State:NE
Practice Address - Zip Code:68023-8201
Practice Address - Country:US
Practice Address - Phone:913-704-8012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-13
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7318122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist