Provider Demographics
NPI:1972508745
Name:IMEL, TERRY L (DDS)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:L
Last Name:IMEL
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 1:504 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GOODLAND
Mailing Address - State:KS
Mailing Address - Zip Code:67735-1842
Mailing Address - Country:US
Mailing Address - Phone:785-899-6222
Mailing Address - Fax:785-890-3650
Practice Address - Street 1:504 MAIN ST
Practice Address - Street 2:
Practice Address - City:GOODLAND
Practice Address - State:KS
Practice Address - Zip Code:67735-1842
Practice Address - Country:US
Practice Address - Phone:785-899-6222
Practice Address - Fax:785-890-3650
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS55241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice