Provider Demographics
NPI:1255427035
Name:CALLISON, TERRY EDWARD (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:EDWARD
Last Name:CALLISON
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:19410 JETTON ROAD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031
Mailing Address - Country:US
Mailing Address - Phone:704-237-9022
Mailing Address - Fax:704-237-9025
Practice Address - Street 1:19410 JETTON ROAD
Practice Address - Street 2:SUITE 210
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031
Practice Address - Country:US
Practice Address - Phone:704-237-9022
Practice Address - Fax:704-237-9025
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3289122300000X
NC77061223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223E0200XDental ProvidersDentistEndodontics