Provider Demographics
NPI:1780740084
Name:MAHONEY, TERRANCE P (DDS)
Entity type:Individual
Prefix:DR
First Name:TERRANCE
Middle Name:P
Last Name:MAHONEY
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 1:17901 TURNERS DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46635-1529
Mailing Address - Country:US
Mailing Address - Phone:574-272-0466
Mailing Address - Fax:574-277-5217
Practice Address - Street 1:17901 TURNERS DR
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46635-1529
Practice Address - Country:US
Practice Address - Phone:574-272-0466
Practice Address - Fax:574-277-5217
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12008169A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist