Provider Demographics
NPI:1568767366
Name:TEETERS, DEBRA JENNINGS (DMD)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:JENNINGS
Last Name:TEETERS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2725 HORSE PEN CREEK RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-8391
Mailing Address - Country:US
Mailing Address - Phone:336-855-3060
Mailing Address - Fax:336-855-1304
Practice Address - Street 1:2725 HORSE PEN CREEK RD
Practice Address - Street 2:SUITE 105
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-8391
Practice Address - Country:US
Practice Address - Phone:336-855-3060
Practice Address - Fax:336-855-1304
Is Sole Proprietor?:No
Enumeration Date:2011-01-26
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC72201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice