Provider Demographics
NPI:1639207285
Name:UNFRIED, TERRY HUBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:HUBERT
Last Name:UNFRIED
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 1:11274 S 350 E
Mailing Address - Street 2:
Mailing Address - City:HAUBSTADT
Mailing Address - State:IN
Mailing Address - Zip Code:47639
Mailing Address - Country:US
Mailing Address - Phone:812-753-4457
Mailing Address - Fax:812-753-4458
Practice Address - Street 1:808 E MULBERRY ST
Practice Address - Street 2:
Practice Address - City:FORT BRANCH
Practice Address - State:IN
Practice Address - Zip Code:47648-1665
Practice Address - Country:US
Practice Address - Phone:812-753-4457
Practice Address - Fax:812-753-4458
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12007533A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice