Terrance Christopher Leary, DDS

Key facts

NPI

1104891894

Entity type

Individual (NPI type 1)

Primary specialty

General Practice Dentistry 1223G0001X

License

2901013381 (MI)

Practice address

2005 Knight Lane BLDG H
Navy Medicine Support Command Attn: Medical Staff SVCS
Jacksonville, FL 32212-0140

Phone

(858) 577-1825

Fax

(858) 577-7773

NPI assigned

Feb 17, 2006

Sex

Male

Sole proprietor

No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• United States Navy Military Ambulatory Procedure Visits Operational (Transportable) Clinic/Center · Jacksonville, FL · NPI 1043632771
  NPD (past)

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Practice roles

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Feb 20, 2009.

{
    "created_epoch": "1140134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1235088000000",
    "number": "1104891894",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19871 MITSCHER WAY",
            "city": "MIRAMAR",
            "state": "CA",
            "postal_code": "921452102",
            "telephone_number": "858-577-1825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2005 KNIGHT LANE BLDG H",
            "address_2": "NAVY MEDICINE SUPPORT COMMAND ATTN: MEDICAL STAFF SVCS",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322120140",
            "telephone_number": "858-577-1825",
            "fax_number": "858-577-7773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEARY",
        "first_name": "TERRANCE",
        "middle_name": "CHRISTOPHER",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-17",
        "last_updated": "2009-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901013381",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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