Provider Demographics
NPI:1528192358
Name:MOEN, TERRENCE K (DDS)
Entity Type:Individual
Prefix:
First Name:TERRENCE
Middle Name:K
Last Name:MOEN
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 1:784 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:RICHLAND CENTER
Mailing Address - State:WI
Mailing Address - Zip Code:53581-1502
Mailing Address - Country:US
Mailing Address - Phone:608-647-3222
Mailing Address - Fax:608-647-7120
Practice Address - Street 1:784 CEDAR ST
Practice Address - Street 2:
Practice Address - City:RICHLAND CENTER
Practice Address - State:WI
Practice Address - Zip Code:53581-1502
Practice Address - Country:US
Practice Address - Phone:608-647-3222
Practice Address - Fax:608-647-7120
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI40871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice