Provider Demographics
NPI:1437111721
Name:TERRY, RONALD B (DMD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:B
Last Name:TERRY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2340 LEGACY CIR STE 2
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:CO
Mailing Address - Zip Code:80107-8302
Mailing Address - Country:US
Mailing Address - Phone:303-646-6336
Mailing Address - Fax:303-646-5355
Practice Address - Street 1:BLDG 38717, 38TH ST
Practice Address - Street 2:USA DENTAC
Practice Address - City:FT GORDON
Practice Address - State:GA
Practice Address - Zip Code:30905-5660
Practice Address - Country:US
Practice Address - Phone:706-787-6927
Practice Address - Fax:706-787-2082
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10143122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist