Provider Demographics
NPI:1467199083
Name:TOOMA, TERAH LEIGH (DMD)
Entity Type:Individual
Prefix:
First Name:TERAH
Middle Name:LEIGH
Last Name:TOOMA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:TERAH
Other - Middle Name:LEIGH
Other - Last Name:WILLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 82969
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33682-2969
Mailing Address - Country:US
Mailing Address - Phone:813-397-5300
Mailing Address - Fax:813-866-0930
Practice Address - Street 1:302 W FLETCHER AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-3415
Practice Address - Country:US
Practice Address - Phone:813-397-5300
Practice Address - Fax:813-549-7855
Is Sole Proprietor?:No
Enumeration Date:2022-05-16
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN26857122300000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program