Provider Demographics
NPI:1558463109
Name:DEVORE, TERRY TOBIAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:TOBIAS
Last Name:DEVORE
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:PO BOX 1389
Mailing Address - Street 2:
Mailing Address - City:SPIRIT LAKE
Mailing Address - State:ID
Mailing Address - Zip Code:83869-1389
Mailing Address - Country:US
Mailing Address - Phone:208-623-6400
Mailing Address - Fax:208-623-6464
Practice Address - Street 1:6070 W. JACKSON STREET
Practice Address - Street 2:
Practice Address - City:SPIRIT LAKE
Practice Address - State:ID
Practice Address - Zip Code:83869
Practice Address - Country:US
Practice Address - Phone:208-623-6400
Practice Address - Fax:208-623-6464
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-03
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-3702122300000X
KY8168122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist