Individual
TERRY ANNEX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
64 OLD ORCHARD CENTER, SUITE 616, SKOKIE, IL 60077-1421
(847) 675-2090
(847) 675-7053
Mailing address
64 OLD ORCHARD CENTER, SUITE 616, SKOKIE, IL 60077-1421
(847) 675-2090
(847) 675-7053
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
19-A12871
IL
Other
Enumeration date
08/01/2006
Last updated
07/08/2007
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