Provider Demographics
NPI:1578542379
Name:WEST, TERRY S (DDS)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:S
Last Name:WEST
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 1:788 S ROUTE 4
Mailing Address - Street 2:APT 607
Mailing Address - City:SINAJANA
Mailing Address - State:GU
Mailing Address - Zip Code:96910-3357
Mailing Address - Country:US
Mailing Address - Phone:671-472-5018
Mailing Address - Fax:
Practice Address - Street 1:U.S. NAVAL HOSPITAL GUAM
Practice Address - Street 2:FARENHOLT STREET BUILDING K-1
Practice Address - City:AGANA HEIGHTS
Practice Address - State:GU
Practice Address - Zip Code:96919
Practice Address - Country:US
Practice Address - Phone:671-339-8086
Practice Address - Fax:671-339-4169
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC55731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice