Provider Demographics
NPI:1386824092
Name:TERRY E. CALLISON, D.D.S., M.S., P.A.
Entity Type:Organization
Organization Name:TERRY E. CALLISON, D.D.S., M.S., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:E
Authorized Official - Last Name:CALLISON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:704-237-9022
Mailing Address - Street 1:19410 JETTON RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-4411
Mailing Address - Country:US
Mailing Address - Phone:704-237-9022
Mailing Address - Fax:704-237-9025
Practice Address - Street 1:19410 JETTON RD
Practice Address - Street 2:SUITE 210
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-4411
Practice Address - Country:US
Practice Address - Phone:704-237-9022
Practice Address - Fax:704-237-9025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7706261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental