Provider Demographics
NPI:1720386824
Name:TERRY FAMILY DENTAL, PC
Entity Type:Organization
Organization Name:TERRY FAMILY DENTAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:RANDELL
Authorized Official - Middle Name:SHANE
Authorized Official - Last Name:TERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:903-873-2523
Mailing Address - Street 1:209 CORKY BOYD AVE
Mailing Address - Street 2:
Mailing Address - City:WILLS POINT
Mailing Address - State:TX
Mailing Address - Zip Code:75169-2815
Mailing Address - Country:US
Mailing Address - Phone:903-873-2523
Mailing Address - Fax:903-873-4405
Practice Address - Street 1:209 CORKY BOYD AVE
Practice Address - Street 2:
Practice Address - City:WILLS POINT
Practice Address - State:TX
Practice Address - Zip Code:75169-2815
Practice Address - Country:US
Practice Address - Phone:903-873-2523
Practice Address - Fax:903-873-4405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-14
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty