Provider Demographics
NPI:1629078738
Name:FROST, TERRY C (DDS)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:C
Last Name:FROST
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 239
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:OH
Mailing Address - Zip Code:45106-0239
Mailing Address - Country:US
Mailing Address - Phone:513-734-7107
Mailing Address - Fax:513-734-3262
Practice Address - Street 1:320 W PLANE ST
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:OH
Practice Address - Zip Code:45106-1310
Practice Address - Country:US
Practice Address - Phone:513-734-7107
Practice Address - Fax:513-734-3262
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHO179781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice