Provider Demographics
NPI:1336283597
Name:KEVIN B. TERRELL, DDS, P.C.
Entity Type:Organization
Organization Name:KEVIN B. TERRELL, DDS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:B
Authorized Official - Last Name:TERRELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:413-263-6618
Mailing Address - Street 1:367 MEMORIAL AVE
Mailing Address - Street 2:
Mailing Address - City:W SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-4007
Mailing Address - Country:US
Mailing Address - Phone:413-263-6616
Mailing Address - Fax:
Practice Address - Street 1:367 MEMORIAL AVE
Practice Address - Street 2:
Practice Address - City:W SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-4007
Practice Address - Country:US
Practice Address - Phone:413-263-6616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2008-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA22222122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty