Provider Demographics
NPI:1710522958
Name:POOLE, TERA (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:TERA
Middle Name:
Last Name:POOLE
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5361 GRAND VISTA CT
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45227-1955
Mailing Address - Country:US
Mailing Address - Phone:513-560-0212
Mailing Address - Fax:
Practice Address - Street 1:8050 HOSBROOK RD STE 310
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-2907
Practice Address - Country:US
Practice Address - Phone:513-772-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-12
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1046951223X0400X
OH30.025691122300000X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist