Provider Demographics
NPI:1942314760
Name:STILLO, TERENCE F
Entity Type:Individual
Prefix:DR
First Name:TERENCE
Middle Name:F
Last Name:STILLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 S ELISEO DR
Mailing Address - Street 2:
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904-2024
Mailing Address - Country:US
Mailing Address - Phone:415-461-9595
Mailing Address - Fax:414-461-2335
Practice Address - Street 1:1321 S ELISEO DR
Practice Address - Street 2:
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-2024
Practice Address - Country:US
Practice Address - Phone:415-461-9595
Practice Address - Fax:414-461-2335
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA221101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice