Provider Demographics
NPI:1942567565
Name:TERVEEN, MICHAEL DAVID (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DAVID
Last Name:TERVEEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1935 N UNION BLVD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-2229
Mailing Address - Country:US
Mailing Address - Phone:719-634-4805
Mailing Address - Fax:719-633-8058
Practice Address - Street 1:1935 N UNION BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-2229
Practice Address - Country:US
Practice Address - Phone:719-634-4805
Practice Address - Fax:719-633-8058
Is Sole Proprietor?:No
Enumeration Date:2012-04-19
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.002026761223G0001X
NMDD3674122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist