Provider Demographics
NPI:1720066673
Name:TERRERO, IVAN E (DDS)
Entity type:Individual
Prefix:DR
First Name:IVAN
Middle Name:E
Last Name:TERRERO
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 1:26800 S TAMIAMI TRL
Mailing Address - Street 2:SUITE 350
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134-4349
Mailing Address - Country:US
Mailing Address - Phone:239-676-9696
Mailing Address - Fax:239-221-7161
Practice Address - Street 1:26800 S TAMIAMI TRL
Practice Address - Street 2:SUITE 350
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-4349
Practice Address - Country:US
Practice Address - Phone:239-676-9696
Practice Address - Fax:239-221-7161
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-01
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043274122300000X
FLDN17477122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist