Provider Demographics
NPI:1578788345
Name:NESSIF, TERRANCE EDWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:TERRANCE
Middle Name:EDWARD
Last Name:NESSIF
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 1:29633 SHELBOURNE RD
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-3454
Mailing Address - Country:US
Mailing Address - Phone:419-666-1215
Mailing Address - Fax:419-475-2572
Practice Address - Street 1:4646 NANTUCKETT DR
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-3194
Practice Address - Country:US
Practice Address - Phone:419-472-2621
Practice Address - Fax:419-475-2572
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH122901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice