Provider Demographics
NPI:1962765784
Name:TERRASSA REYES, ISABELLA (DMD)
Entity type:Individual
Prefix:DR
First Name:ISABELLA
Middle Name:
Last Name:TERRASSA REYES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:MISS
Other - First Name:ISABELLA
Other - Middle Name:
Other - Last Name:TERRASSA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:25 E WASHINGTON ST STE 1917
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-1808
Mailing Address - Country:US
Mailing Address - Phone:312-726-3135
Mailing Address - Fax:
Practice Address - Street 1:25 E WASHINGTON ST STE 1917
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-1808
Practice Address - Country:US
Practice Address - Phone:312-726-3135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-18
Last Update Date:2024-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019029465122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist