Provider Demographics
NPI:1316511207
Name:TEEL, CARL JEROME III (DDS)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:JEROME
Last Name:TEEL
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:TREY
Other - Middle Name:
Other - Last Name:TEEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:54 EXETER RD STE A
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-1985
Mailing Address - Country:US
Mailing Address - Phone:731-668-9898
Mailing Address - Fax:
Practice Address - Street 1:54 EXETER RD STE A
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-1985
Practice Address - Country:US
Practice Address - Phone:731-668-9898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11563122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist