Provider Demographics
NPI:1770739476
Name:MARQUARD, TERRY LEE (DDS)
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:LEE
Last Name:MARQUARD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5171 WALLINGS RD
Mailing Address - Street 2:
Mailing Address - City:NORTH ROYALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44133-3197
Mailing Address - Country:US
Mailing Address - Phone:440-237-1700
Mailing Address - Fax:440-237-5649
Practice Address - Street 1:5171 WALLINGS RD
Practice Address - Street 2:
Practice Address - City:NORTH ROYALTON
Practice Address - State:OH
Practice Address - Zip Code:44133-3197
Practice Address - Country:US
Practice Address - Phone:440-237-1700
Practice Address - Fax:440-237-5649
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH167711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice