Provider Demographics
NPI:1922491273
Name:TERRY D. AHN DDS., INC
Entity Type:Organization
Organization Name:TERRY D. AHN DDS., INC
Other - Org Name:MAYWOOD DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:AHN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-560-3131
Mailing Address - Street 1:6059 ATLANTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90270-3118
Mailing Address - Country:US
Mailing Address - Phone:323-560-3131
Mailing Address - Fax:
Practice Address - Street 1:6059 ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90270-3118
Practice Address - Country:US
Practice Address - Phone:323-560-3131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:7727
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-03-11
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54576261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental