Provider Demographics
NPI:1902926959
Name:WHITTEN, TERRY ANNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:ANNE
Last Name:WHITTEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 GREENWOOD CT
Mailing Address - Street 2:
Mailing Address - City:TIBURON
Mailing Address - State:CA
Mailing Address - Zip Code:94920-2016
Mailing Address - Country:US
Mailing Address - Phone:415-265-7590
Mailing Address - Fax:415-380-8700
Practice Address - Street 1:1 GREENWOOD CT
Practice Address - Street 2:
Practice Address - City:TIBURON
Practice Address - State:CA
Practice Address - Zip Code:94920-2016
Practice Address - Country:US
Practice Address - Phone:415-265-7590
Practice Address - Fax:415-380-8700
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300501223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics