Provider Demographics
NPI:1144379546
Name:DR. TERRY SCOTESE
Entity type:Organization
Organization Name:DR. TERRY SCOTESE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:C
Authorized Official - Last Name:SCOTESE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,MSD
Authorized Official - Phone:440-205-1222
Mailing Address - Street 1:9179 MENTOR AVE UNIT K
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-6398
Mailing Address - Country:US
Mailing Address - Phone:440-205-1222
Mailing Address - Fax:440-974-5474
Practice Address - Street 1:9179 MENTOR AVE UNIT K
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-6398
Practice Address - Country:US
Practice Address - Phone:440-205-1222
Practice Address - Fax:440-974-5474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-01-62481223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH30-01-6248OtherDENTIST LICENSE