Provider Demographics
NPI:1639747686
Name:TERA L DEPAOLI, DMD, LLC
Entity Type:Organization
Organization Name:TERA L DEPAOLI, DMD, LLC
Other - Org Name:DEPAOLI DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERA
Authorized Official - Middle Name:L
Authorized Official - Last Name:DEPAOLI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:724-443-4444
Mailing Address - Street 1:4984 MIDDLE RD
Mailing Address - Street 2:
Mailing Address - City:GIBSONIA
Mailing Address - State:PA
Mailing Address - Zip Code:15044-8276
Mailing Address - Country:US
Mailing Address - Phone:724-443-4444
Mailing Address - Fax:
Practice Address - Street 1:4984 MIDDLE RD
Practice Address - Street 2:
Practice Address - City:GIBSONIA
Practice Address - State:PA
Practice Address - Zip Code:15044-8276
Practice Address - Country:US
Practice Address - Phone:724-443-4444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-16
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty