Gary M Tetrick, DDS PS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DE0000455Z Issued in WA

Practice address

3628 Meridian St
Ste 1-C
Bellingham, WA 98225

Phone

(360) 734-4374

Fax

(360) 715-9196

NPI assigned

Aug 11, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Bellingham Family Dentistry

  • Dental Clinic/Center
  • Bellingham, WA
  • NPI 1114261187
  NPD (past)
• Jill Tetrick DDS, PLLC

  • General Practice Dentistry
  • Bellingham, WA
  • NPI 1932613684
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1114938313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3628 MERIDIAN ST",
            "address_2": "STE 1-C",
            "city": "BELLINGHAM",
            "state": "WA",
            "postal_code": "98225",
            "telephone_number": "360-734-4374",
            "fax_number": "360-715-9196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3628 MERIDIAN ST",
            "address_2": "STE 1-C",
            "city": "BELLINGHAM",
            "state": "WA",
            "postal_code": "98225",
            "telephone_number": "360-734-4374",
            "fax_number": "360-715-9196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TETRICK",
        "first_name": "GARY",
        "middle_name": "M",
        "credential": "DDS PS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE0000455Z",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5514005",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Daniel F Terry, D.C.
• Debra Terry, LMP
• Julie K Terry, M.D.
• Sky Wynn Terry, LPN
• Roger C Teshera
• Jill Noelle Tetrick, DDS
• Agazi Teweldeberhan
• Kristyn Marie Than, LMHC
• Jodi Morgan Tharan
• Sean Curtis Thayer

• General Practice Dentistry in Bellingham, WA
• Providers in Bellingham, WA by specialty
• General Practice Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.