Provider Demographics
NPI:1831352509
Name:TERRY, THEODORE ANTHONY (DDS)
Entity type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:ANTHONY
Last Name:TERRY
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 1:11 S MILL ST STE 200
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16101-3680
Mailing Address - Country:US
Mailing Address - Phone:724-698-2132
Mailing Address - Fax:844-399-0385
Practice Address - Street 1:1730 SCHROCK RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-1575
Practice Address - Country:US
Practice Address - Phone:614-890-1333
Practice Address - Fax:614-890-4945
Is Sole Proprietor?:No
Enumeration Date:2008-07-03
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30023199122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3060397Medicaid