Provider Demographics
NPI:1104891894
Name:LEARY, TERRANCE CHRISTOPHER (DDS)
Entity type:Individual
Prefix:DR
First Name:TERRANCE
Middle Name:CHRISTOPHER
Last Name:LEARY
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 1:19871 MITSCHER WAY
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:CA
Mailing Address - Zip Code:92145-2102
Mailing Address - Country:US
Mailing Address - Phone:858-577-1825
Mailing Address - Fax:
Practice Address - Street 1:2005 KNIGHT LANE BLDG H
Practice Address - Street 2:NAVY MEDICINE SUPPORT COMMAND ATTN: MEDICAL STAFF SVCS
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32212-0140
Practice Address - Country:US
Practice Address - Phone:858-577-1825
Practice Address - Fax:858-577-7773
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010133811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice