Provider Demographics
NPI:1518015775
Name:ALDERETTE, TERENCE LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:TERENCE
Middle Name:LEE
Last Name:ALDERETTE
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 1:1348 E RUTH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-3266
Mailing Address - Country:US
Mailing Address - Phone:602-395-9944
Mailing Address - Fax:
Practice Address - Street 1:1277 E MISSOURI AVE
Practice Address - Street 2:SUITE 117
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-2915
Practice Address - Country:US
Practice Address - Phone:602-274-9791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ36181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice