Healthcare Provider Details

I. General information

NPI: 1164523742
Provider Name (Legal Business Name): TERRY D CISLER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1602 N RANDALL AVE
JANESVILLE WI
53545-1124
US

IV. Provider business mailing address

104 SEMINOLE ROAD
JANESVILLE WI
53545-1124
US

V. Phone/Fax

Practice location:
  • Phone: 608-756-8744
  • Fax: 608-756-5344
Mailing address:
  • Phone: 608-756-8744
  • Fax: 608-756-5344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number5001150
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: