Provider Demographics
NPI:1528130911
Name:TIERSKY, TERRI S (DDS)
Entity type:Individual
Prefix:DR
First Name:TERRI
Middle Name:S
Last Name:TIERSKY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5550 TOUHY AVE
Mailing Address - Street 2:#402
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-3253
Mailing Address - Country:US
Mailing Address - Phone:773-286-3750
Mailing Address - Fax:847-423-2939
Practice Address - Street 1:4200 W PETERSON AVE
Practice Address - Street 2:#136
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-6074
Practice Address - Country:US
Practice Address - Phone:773-286-3750
Practice Address - Fax:773-286-5331
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190201801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice