Provider Demographics
NPI:1487675302
Name:TERRANCE F MCGOVERN DDS PC
Entity type:Organization
Organization Name:TERRANCE F MCGOVERN DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRANCE
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:MCGOVERN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:508-754-0918
Mailing Address - Street 1:715 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01602-1904
Mailing Address - Country:US
Mailing Address - Phone:508-754-0918
Mailing Address - Fax:508-756-1518
Practice Address - Street 1:715 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01602-1904
Practice Address - Country:US
Practice Address - Phone:508-754-0918
Practice Address - Fax:508-756-1518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA140221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty