Provider Demographics
NPI:1548425283
Name:DR. I. TERRERO, PA
Entity Type:Organization
Organization Name:DR. I. TERRERO, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:EDUARDO
Authorized Official - Last Name:TERRERO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:954-963-8282
Mailing Address - Street 1:5351 SHERIDAN ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3342
Mailing Address - Country:US
Mailing Address - Phone:954-963-8282
Mailing Address - Fax:
Practice Address - Street 1:5351 SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3342
Practice Address - Country:US
Practice Address - Phone:954-963-8282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-22
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN17477122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty