Provider Demographics
NPI:1861582553
Name:MICHIELS, TERENCE JOSEPH (DDS)
Entity type:Individual
Prefix:
First Name:TERENCE
Middle Name:JOSEPH
Last Name:MICHIELS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 WAUKEGAN RD
Mailing Address - Street 2:
Mailing Address - City:LAKE BLUFF
Mailing Address - State:IL
Mailing Address - Zip Code:60044-1666
Mailing Address - Country:US
Mailing Address - Phone:847-615-9422
Mailing Address - Fax:
Practice Address - Street 1:225 WAUKEGAN RD
Practice Address - Street 2:
Practice Address - City:LAKE BLUFF
Practice Address - State:IL
Practice Address - Zip Code:60044-1666
Practice Address - Country:US
Practice Address - Phone:847-615-9422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-024214122300000X
OH30.021488122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist