MEDICARE: DR. MICHAEL TERNISKY DDS

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	3553	VA

General Provider Information

NPI Number	:	1811087935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL TERNISKY DDS

Provider Business Mailing Address
First Line	:	6711 WHITTIER AVE
Second Line	:
City	:	MCLEAN
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	:	#102
City	:	MCLEAN
State	:	VA
Zip	:	22101-4538
Country	:	US
Telephone Number	:	703-356-1875
Fax Number	:	703-749-5344

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

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	07/08/2007

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