Provider Demographics
NPI:1164523742
Name:CISLER, TERRY D (DDS)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:D
Last Name:CISLER
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 1:104 SEMINOLE ROAD
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53545-1124
Mailing Address - Country:US
Mailing Address - Phone:608-756-8744
Mailing Address - Fax:608-756-5344
Practice Address - Street 1:1602 N RANDALL AVE
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53545-1124
Practice Address - Country:US
Practice Address - Phone:608-756-8744
Practice Address - Fax:608-756-5344
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI50011501223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1008520OtherPHYSICIANS PLUS INSURANCE
WI1020OtherDEAN HEALTH CARE
WIT61671Medicare UPIN
WI1020OtherDEAN HEALTH CARE