Provider Demographics
NPI:1164684726
Name:SHUTTS, TERRANCE BRYAN (DDS)
Entity type:Individual
Prefix:DR
First Name:TERRANCE
Middle Name:BRYAN
Last Name:SHUTTS
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 1:19 COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-1602
Mailing Address - Country:US
Mailing Address - Phone:405-826-2392
Mailing Address - Fax:058-262-3924
Practice Address - Street 1:332 WASHINGTON ST
Practice Address - Street 2:MEZZANINE LEVEL
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-0248
Practice Address - Country:US
Practice Address - Phone:781-222-4738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-25
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1855321122300000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist