MEDICARE: DR. TERENCE A DEADY D.D.S.

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	1223G0001X	General Practice Dentistry		IL

General Provider Information

NPI Number	:	1134207517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERENCE A DEADY D.D.S.

Provider Business Mailing Address
First Line	:	12912 S LA GRANGE RD
Second Line	:
City	:	PALOS PARK
State	:	IL
Zip	:	60464-1717
Country	:	US
Telephone Number	:	708-448-1070
Fax Number	:	708-448-9031

Provider Business Practice Location Address
First Line	:	12912 S LA GRANGE RD
Second Line	:
City	:	PALOS PARK
State	:	IL
Zip	:	60464-1717
Country	:	US
Telephone Number	:	708-448-1070
Fax Number	:	708-448-9031

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	07/08/2007

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