Provider Demographics
NPI:1477678217
Name:TRANTER, TERA M (DDS)
Entity Type:Individual
Prefix:
First Name:TERA
Middle Name:M
Last Name:TRANTER
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 1:2842 BOYER ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208-0702
Mailing Address - Country:US
Mailing Address - Phone:704-399-4531
Mailing Address - Fax:
Practice Address - Street 1:2842 BOYER ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-0702
Practice Address - Country:US
Practice Address - Phone:704-399-4531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC159111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID26-2998604OtherTAX ID NUMBER