DR. Ted A Deatherage, D.M.D.

NPI #1689721813 in West Plains, Missouri

Provider Information

NPI Number: 1689721813
Entity Type: Individual
Name: DR. Ted A Deatherage, D.M.D.
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Dentist
Credential: D.M.D.
Enumeration Date: Jan 3, 2007
Last Updated: Jul 8, 2007

Practice Location

Address: 1616 GIBSON ST
City: West Plains
State: Missouri
ZIP Code: 65775-1814
Phone: (417) 257-0126

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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