Provider Demographics
NPI:1649246869
Name:TERRY L IMEL, D.D.S.
Entity type:Organization
Organization Name:TERRY L IMEL, D.D.S.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:IMEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:785-899-6222
Mailing Address - Street 1:504 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GOODLAND
Mailing Address - State:KS
Mailing Address - Zip Code:67735-1842
Mailing Address - Country:US
Mailing Address - Phone:785-899-6222
Mailing Address - Fax:785-890-3650
Practice Address - Street 1:504 MAIN ST
Practice Address - Street 2:
Practice Address - City:GOODLAND
Practice Address - State:KS
Practice Address - Zip Code:67735-1842
Practice Address - Country:US
Practice Address - Phone:785-899-6222
Practice Address - Fax:785-890-3650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS55241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty