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General NPI Number Information
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NPI Number | 1861582553
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Entity Type | Individual
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Provider Name | TERENCE JOSEPH MICHIELS D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 225 WAUKEGAN RD
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City | LAKE BLUFF
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State | IL
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Zip | 60044-1666
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Country | US
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Telephone | 847-615-9422
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Fax |
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Provider Business Mailing Address
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Address Line | 225 WAUKEGAN RD
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City | LAKE BLUFF
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State | IL
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Zip | 60044-1666
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Country | US
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Telephone | 847-615-9422
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019-024214
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 30.021488
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License Number State | OH
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