Provider Demographics
NPI:1598985962
Name:STIEGLITZ, TERRY ROBERT (DMD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:ROBERT
Last Name:STIEGLITZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5064 NANDINA LN
Mailing Address - Street 2:
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-4113
Mailing Address - Country:US
Mailing Address - Phone:770-394-9390
Mailing Address - Fax:
Practice Address - Street 1:5064 NANDINA LN
Practice Address - Street 2:
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-4113
Practice Address - Country:US
Practice Address - Phone:770-394-9390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0078101223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics