Provider Demographics
NPI:1912574302
Name:TERRY, KAITLYN CLAIRE
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:CLAIRE
Last Name:TERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 NEW RD APT D10
Mailing Address - Street 2:
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054-4253
Mailing Address - Country:US
Mailing Address - Phone:973-525-9849
Mailing Address - Fax:
Practice Address - Street 1:2739 ROUTE 23
Practice Address - Street 2:
Practice Address - City:STOCKHOLM
Practice Address - State:NJ
Practice Address - Zip Code:07460-1304
Practice Address - Country:US
Practice Address - Phone:973-697-5440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-05
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI028387001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice