Provider Demographics
NPI:1679754774
Name:TERLECKE, LINDA JEAN (DDS)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:JEAN
Last Name:TERLECKE
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 1:3968 N 68TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-2012
Mailing Address - Country:US
Mailing Address - Phone:414-463-5480
Mailing Address - Fax:414-463-8003
Practice Address - Street 1:3968 N 68TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-2012
Practice Address - Country:US
Practice Address - Phone:414-463-5480
Practice Address - Fax:414-463-8003
Is Sole Proprietor?:No
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3040-015122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist