Provider Demographics
NPI:1811087935
Name:TERNISKY, MICHAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:TERNISKY
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 1:6711 WHITTIER AVE
Mailing Address - Street 2:
Mailing Address - City:MCLEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-4538
Mailing Address - Country:US
Mailing Address - Phone:703-356-1875
Mailing Address - Fax:
Practice Address - Street 1:6711 WHITTIER AVE
Practice Address - Street 2:#102
Practice Address - City:MCLEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-4538
Practice Address - Country:US
Practice Address - Phone:703-356-1875
Practice Address - Fax:703-749-5344
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
VA35531223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry