Provider Demographics
NPI:1760642284
Name:IVAN TERRERO DDS PA
Entity Type:Organization
Organization Name:IVAN TERRERO DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:EDUARDO
Authorized Official - Last Name:TERRERO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:917-796-7624
Mailing Address - Street 1:555 WASHINGTON AVE
Mailing Address - Street 2:STE 350
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33139-6643
Mailing Address - Country:US
Mailing Address - Phone:305-604-5707
Mailing Address - Fax:
Practice Address - Street 1:15436-7 NW 77TH COURT
Practice Address - Street 2:#150 & 160
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016
Practice Address - Country:US
Practice Address - Phone:305-557-5775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN174771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty