Provider Demographics
NPI:1811067572
Name:ANGEVINE, TERRY T (DDS)
Entity type:Individual
Prefix:MR
First Name:TERRY
Middle Name:T
Last Name:ANGEVINE
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Gender:M
Credentials:DDS
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Mailing Address - Street 1:651 CROSS TIMBERS ROAD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028
Mailing Address - Country:US
Mailing Address - Phone:972-436-1513
Mailing Address - Fax:972-436-0618
Practice Address - Street 1:651 CROSS TIMBERS ROAD
Practice Address - Street 2:SUITE 103
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028
Practice Address - Country:US
Practice Address - Phone:972-436-1513
Practice Address - Fax:972-436-0618
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
TX10671204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
T11963Medicare UPIN