MEDICARE: MICHAEL J. TERNISKY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry

General Provider Information

NPI Number	:	1114366903
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL J. TERNISKY

Provider Business Mailing Address
First Line	:	6711 WHITTIER AVE
Second Line	:
City	:	MC LEAN
State	:	VA
Zip	:	22101-4538
Country	:	US
Telephone Number	:	703-356-1875
Fax Number	:

Provider Business Practice Location Address
First Line	:	6711 WHITTIER AVE
Second Line	:
City	:	MC LEAN
State	:	VA
Zip	:	22101-4538
Country	:	US
Telephone Number	:	703-356-1875
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MICHAEL J TERNISKY
Credential	:	DDS
Telephone Number	:	703-356-1875

Provider Enumeration Date	:	06/14/2013
Last Update Date	:	06/14/2013

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