Provider Demographics
NPI:1134884406
Name:MAIER, TERI MILLER
Entity type:Individual
Prefix:
First Name:TERI
Middle Name:MILLER
Last Name:MAIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3465 VIDRINE RD
Mailing Address - Street 2:
Mailing Address - City:VILLE PLATTE
Mailing Address - State:LA
Mailing Address - Zip Code:70586-8603
Mailing Address - Country:US
Mailing Address - Phone:337-831-5455
Mailing Address - Fax:
Practice Address - Street 1:3465 VIDRINE RD
Practice Address - Street 2:
Practice Address - City:VILLE PLATTE
Practice Address - State:LA
Practice Address - Zip Code:70586-8603
Practice Address - Country:US
Practice Address - Phone:337-831-5455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2762174400000X, 124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty
No174400000XOther Service ProvidersSpecialist