Provider Demographics
NPI:1376605907
Name:DE BORD, TERRIE KAYE (DDS)
Entity Type:Individual
Prefix:DR
First Name:TERRIE
Middle Name:KAYE
Last Name:DE BORD
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 1:7601 IMPERIAL HWY
Mailing Address - Street 2:RLANRC DENTISTRY HB 146
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90242-3456
Mailing Address - Country:US
Mailing Address - Phone:562-401-7254
Mailing Address - Fax:562-401-7679
Practice Address - Street 1:7601 IMPERIAL HWY
Practice Address - Street 2:RLANRC DENTISTRY HB 146
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242-3456
Practice Address - Country:US
Practice Address - Phone:562-401-7254
Practice Address - Fax:562-401-7679
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADB305511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice