Provider Demographics
NPI:1992851463
Name:TEREBA, CAROL A (DDS)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:A
Last Name:TEREBA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 FOX RUN
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44410-1171
Mailing Address - Country:US
Mailing Address - Phone:330-637-7670
Mailing Address - Fax:
Practice Address - Street 1:2900 ELM RD NE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-2606
Practice Address - Country:US
Practice Address - Phone:330-372-1236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH203381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000088745Medicaid
OH341871974026Medicaid
OH0204764Medicaid