Provider Demographics
NPI:1043368111
Name:DEPAOLI, TERA L (DMD)
Entity type:Individual
Prefix:DR
First Name:TERA
Middle Name:L
Last Name:DEPAOLI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4984 MIDDLE RD
Mailing Address - Street 2:
Mailing Address - City:GIBSONIA
Mailing Address - State:PA
Mailing Address - Zip Code:15044-8276
Mailing Address - Country:US
Mailing Address - Phone:724-443-4444
Mailing Address - Fax:724-443-4274
Practice Address - Street 1:4984 MIDDLE RD
Practice Address - Street 2:
Practice Address - City:GIBSONIA
Practice Address - State:PA
Practice Address - Zip Code:15044-8276
Practice Address - Country:US
Practice Address - Phone:724-443-4444
Practice Address - Fax:724-443-4274
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-022313122300000X
PADS0365941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist