Provider Demographics
NPI:1740270933
Name:TERRY, MICHAEL KENT (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:KENT
Last Name:TERRY
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 1:21700 REDWOOD RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-6434
Mailing Address - Country:US
Mailing Address - Phone:510-582-2133
Mailing Address - Fax:510-582-2134
Practice Address - Street 1:21700 REDWOOD RD
Practice Address - Street 2:SUITE A
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-6434
Practice Address - Country:US
Practice Address - Phone:510-582-2133
Practice Address - Fax:510-582-2134
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA324061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice