Provider Demographics
NPI:1013114859
Name:TERHUNE, BRYAN J JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:J
Last Name:TERHUNE
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4407 NORMA DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-3517
Mailing Address - Country:US
Mailing Address - Phone:216-382-4617
Mailing Address - Fax:
Practice Address - Street 1:193 EAST AVE
Practice Address - Street 2:
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-2341
Practice Address - Country:US
Practice Address - Phone:330-633-0324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-022538122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist