Provider Demographics
NPI:1295868693
Name:FORD, TERRI LOGAN (DDS)
Entity type:Individual
Prefix:DR
First Name:TERRI
Middle Name:LOGAN
Last Name:FORD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7141 N. MICHIGAN RD.
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-2700
Mailing Address - Country:US
Mailing Address - Phone:317-297-7900
Mailing Address - Fax:317-297-7765
Practice Address - Street 1:7141 N. MICHIGAN RD.
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-2700
Practice Address - Country:US
Practice Address - Phone:317-297-7900
Practice Address - Fax:317-297-7765
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120090861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100259190AMedicaid