Provider Demographics
NPI:1154431591
Name:POORMAN, TERESA L (DDS)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:L
Last Name:POORMAN
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 1:121 E 31ST ST
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-3001
Mailing Address - Country:US
Mailing Address - Phone:308-234-5437
Mailing Address - Fax:308-234-3169
Practice Address - Street 1:121 E 31ST ST
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-3001
Practice Address - Country:US
Practice Address - Phone:308-234-5437
Practice Address - Fax:308-234-3169
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE56461223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE4778072813Medicaid