Provider Demographics
NPI:1871730309
Name:DRISCOLL, TERRIE LEIGH (DDS)
Entity type:Individual
Prefix:
First Name:TERRIE
Middle Name:LEIGH
Last Name:DRISCOLL
Suffix:
Gender:F
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:PO BOX 786
Mailing Address - Street 2:
Mailing Address - City:GAMBRILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21054-0786
Mailing Address - Country:US
Mailing Address - Phone:410-923-0373
Mailing Address - Fax:410-923-1093
Practice Address - Street 1:325 GAMBRILLS RD
Practice Address - Street 2:SUITE C
Practice Address - City:GAMBRILLS
Practice Address - State:MD
Practice Address - Zip Code:21054-1102
Practice Address - Country:US
Practice Address - Phone:410-923-0373
Practice Address - Fax:410-923-1093
Is Sole Proprietor?:No
Enumeration Date:2009-01-21
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14302122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist