Provider Demographics
NPI:1801965637
Name:DOUGLAS R. TERRY D.D.S., PA
Entity type:Organization
Organization Name:DOUGLAS R. TERRY D.D.S., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:ROGER
Authorized Official - Last Name:TERRY
Authorized Official - Suffix:II
Authorized Official - Credentials:DDS
Authorized Official - Phone:828-758-1906
Mailing Address - Street 1:504 MULBERRY ST SW
Mailing Address - Street 2:
Mailing Address - City:LENOIR
Mailing Address - State:NC
Mailing Address - Zip Code:28645-5725
Mailing Address - Country:US
Mailing Address - Phone:828-758-1906
Mailing Address - Fax:828-758-1989
Practice Address - Street 1:504 MULBERRY ST SW
Practice Address - Street 2:
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-5725
Practice Address - Country:US
Practice Address - Phone:828-758-1906
Practice Address - Fax:828-758-1989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6278122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC=========OtherTAX ID #