Healthcare Provider Details

I. General information

NPI: 1881031482
Provider Name (Legal Business Name): CHRISTOPHER ANDREW TEETERS D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2013
Last Update Date: 05/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7505 W DEER VALLEY RD
PEORIA AZ
85382-2107
US

IV. Provider business mailing address

7505 W DEER VALLEY RD
PEORIA AZ
85382-2107
US

V. Phone/Fax

Practice location:
  • Phone: 415-608-6148
  • Fax:
Mailing address:
  • Phone: 415-608-6148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberD008655
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: