Provider Demographics
NPI:1629743232
Name:OBERLY, TERESA LYNN (RDH)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:LYNN
Last Name:OBERLY
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3941 TAMIAMI TRL UNIT 3171
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-7925
Mailing Address - Country:US
Mailing Address - Phone:941-639-5224
Mailing Address - Fax:941-639-3563
Practice Address - Street 1:3941 TAMIAMI TRL UNIT 3171
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-7925
Practice Address - Country:US
Practice Address - Phone:941-639-5224
Practice Address - Fax:941-639-3563
Is Sole Proprietor?:No
Enumeration Date:2021-08-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH28804124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist