Provider Demographics
NPI:1922154160
Name:ZERVOS, TERRY E (DDS)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:E
Last Name:ZERVOS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:ELEFTHERIOS
Other - Middle Name:E
Other - Last Name:ZERVOUDAKIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:434 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-4964
Mailing Address - Country:US
Mailing Address - Phone:727-736-3032
Mailing Address - Fax:
Practice Address - Street 1:434 MAIN ST
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-4964
Practice Address - Country:US
Practice Address - Phone:727-736-3032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN111851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDN11185OtherSTATE LICENCE#