Provider Demographics
NPI:1215056940
Name:TEBAY, CATHERINE M (DDS)
Entity type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:M
Last Name:TEBAY
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:PO BOX 9520
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83002-9520
Mailing Address - Country:US
Mailing Address - Phone:307-734-5665
Mailing Address - Fax:307-734-6066
Practice Address - Street 1:1325 S. HWY 89
Practice Address - Street 2:SUITE 107
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83002-0000
Practice Address - Country:US
Practice Address - Phone:307-734-5665
Practice Address - Fax:307-734-6066
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYWY10921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice