Provider Demographics
NPI:1164737300
Name:HOUTHOOFD, TERRA SHANNON (DDS)
Entity type:Individual
Prefix:
First Name:TERRA
Middle Name:SHANNON
Last Name:HOUTHOOFD
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 1:1049 N PINE RD
Mailing Address - Street 2:
Mailing Address - City:ESSEXVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48732-1915
Mailing Address - Country:US
Mailing Address - Phone:989-894-4611
Mailing Address - Fax:898-942-6699
Practice Address - Street 1:1049 N PINE RD
Practice Address - Street 2:
Practice Address - City:ESSEXVILLE
Practice Address - State:MI
Practice Address - Zip Code:48732-1915
Practice Address - Country:US
Practice Address - Phone:989-894-4611
Practice Address - Fax:898-942-6699
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-12
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI241820406021223G0001X
MI2901020258122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice