Provider Demographics
NPI:1790870012
Name:TERRI L. BAARSTAD, DMD, PC
Entity Type:Organization
Organization Name:TERRI L. BAARSTAD, DMD, PC
Other - Org Name:SMILEALIVE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:LEANNE
Authorized Official - Last Name:BAARSTAD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:541-683-8396
Mailing Address - Street 1:1045 WILLAGILLESPIE RD STE 250
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-6724
Mailing Address - Country:US
Mailing Address - Phone:541-683-8396
Mailing Address - Fax:
Practice Address - Street 1:1045 WILLAGILLESPIE RD STE 250
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6724
Practice Address - Country:US
Practice Address - Phone:541-683-8396
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD79141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty