Provider Demographics
NPI:1265707400
Name:TRUESDALE, TERRY ALLEN (DDS)
Entity type:Individual
Prefix:MR
First Name:TERRY
Middle Name:ALLEN
Last Name:TRUESDALE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2381 RENAISSANCE DRIVE
Mailing Address - Street 2:SUITE #B
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-6498
Mailing Address - Country:US
Mailing Address - Phone:702-798-1060
Mailing Address - Fax:702-798-0295
Practice Address - Street 1:2381 RENAISSANCE DRIVE
Practice Address - Street 2:SUITE B
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6498
Practice Address - Country:US
Practice Address - Phone:702-798-1060
Practice Address - Fax:702-798-0295
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-21
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2572122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist