Provider Demographics
NPI:1811101629
Name:MAHER, TERESA ROSE (DDS)
Entity type:Individual
Prefix:DR
First Name:TERESA
Middle Name:ROSE
Last Name:MAHER
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 1:1601 S INDIANA AVE
Mailing Address - Street 2:UNIT 102
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-1391
Mailing Address - Country:US
Mailing Address - Phone:312-986-8132
Mailing Address - Fax:312-781-9202
Practice Address - Street 1:1601 S INDIANA AVE
Practice Address - Street 2:UNIT 102
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-1391
Practice Address - Country:US
Practice Address - Phone:312-986-8132
Practice Address - Fax:312-781-9202
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist