Provider Demographics
NPI:1528318367
Name:TERWILLIGER, GAYLE WAGUESPACK (DDS)
Entity type:Individual
Prefix:DR
First Name:GAYLE
Middle Name:WAGUESPACK
Last Name:TERWILLIGER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:GAYLE
Other - Middle Name:ANN
Other - Last Name:TERWILLIGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:10 OAK ALY
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23430-6030
Mailing Address - Country:US
Mailing Address - Phone:757-357-9955
Mailing Address - Fax:
Practice Address - Street 1:1617 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:VA
Practice Address - Zip Code:23430-1831
Practice Address - Country:US
Practice Address - Phone:757-357-7500
Practice Address - Fax:757-357-6323
Is Sole Proprietor?:No
Enumeration Date:2012-09-19
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010073461223G0001X
LA33351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice