Provider Demographics
NPI:1457488157
Name:TERAVEST, JERRY H (DDS)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:H
Last Name:TERAVEST
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:PO BOX 12301
Mailing Address - Street 2:
Mailing Address - City:RESEARCH TRIANGLE PARK
Mailing Address - State:NC
Mailing Address - Zip Code:27709-2301
Mailing Address - Country:US
Mailing Address - Phone:919-544-6080
Mailing Address - Fax:919-544-8252
Practice Address - Street 1:2515 E NC HIGHWAY 54
Practice Address - Street 2:SUITE 2000
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-5263
Practice Address - Country:US
Practice Address - Phone:919-544-6080
Practice Address - Fax:919-544-8252
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC58821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice