Provider Demographics
NPI:1396728945
Name:WILWERDING, TERRY M (DDS)
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:M
Last Name:WILWERDING
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 1:5032 UNDERWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68132-2236
Mailing Address - Country:US
Mailing Address - Phone:402-558-9255
Mailing Address - Fax:
Practice Address - Street 1:5032 UNDERWOOD AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68132-2236
Practice Address - Country:US
Practice Address - Phone:402-558-9255
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4563122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist