Provider Demographics
NPI:1255351649
Name:O'HARE, TERRENCE DILLON (DMD)
Entity type:Individual
Prefix:
First Name:TERRENCE
Middle Name:DILLON
Last Name:O'HARE
Suffix:
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 1:5 W D ST
Mailing Address - Street 2:
Mailing Address - City:LEMOORE
Mailing Address - State:CA
Mailing Address - Zip Code:93245-2935
Mailing Address - Country:US
Mailing Address - Phone:559-924-2206
Mailing Address - Fax:559-924-2225
Practice Address - Street 1:5 W D ST
Practice Address - Street 2:
Practice Address - City:LEMOORE
Practice Address - State:CA
Practice Address - Zip Code:93245-2935
Practice Address - Country:US
Practice Address - Phone:559-924-2206
Practice Address - Fax:559-924-2225
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA331321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA905239OtherUNITED CONCORDIA INSURANC
CA905239OtherUNITED CONCORDIA INSURANC
CA905239OtherUNITED CONCORDIA INSURANC