Provider Demographics
NPI:1023138435
Name:BIGGERSTAFF, TERESA GEHRET (DDS, MD)
Entity type:Individual
Prefix:DR
First Name:TERESA
Middle Name:GEHRET
Last Name:BIGGERSTAFF
Suffix:
Gender:F
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 OLD WINSTON RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-9964
Mailing Address - Country:US
Mailing Address - Phone:336-992-2123
Mailing Address - Fax:336-992-2330
Practice Address - Street 1:900 OLD WINSTON RD
Practice Address - Street 2:SUITE 204
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-9964
Practice Address - Country:US
Practice Address - Phone:336-992-2123
Practice Address - Fax:336-992-2330
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAS-3321223S0112X
CA488571223S0112X
LA200649204E00000X
NC2007-00937204E00000X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5907301Medicaid
LA05740Medicaid
NC5907301Medicaid