Provider Demographics
NPI:1538217542
Name:TERRY, JOYCE ANN (DDS)
Entity type:Individual
Prefix:DR
First Name:JOYCE
Middle Name:ANN
Last Name:TERRY
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 1:1921 170TH ST
Mailing Address - Street 2:
Mailing Address - City:HAZEL CREST
Mailing Address - State:IL
Mailing Address - Zip Code:60429-1361
Mailing Address - Country:US
Mailing Address - Phone:708-335-4955
Mailing Address - Fax:708-335-4223
Practice Address - Street 1:1921 WEST 170TH ST
Practice Address - Street 2:
Practice Address - City:HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60429-1361
Practice Address - Country:US
Practice Address - Phone:708-335-4955
Practice Address - Fax:708-335-4223
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL01921858122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist