Healthcare Provider Details

I. General information

NPI: 1831496785
Provider Name (Legal Business Name): TERECITA DEAN, D.D.S.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2011
Last Update Date: 02/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2017 CENTRAL AVE
ALAMEDA CA
94501-4210
US

IV. Provider business mailing address

2017 CENTRAL AVE
ALAMEDA CA
94501-4210
US

V. Phone/Fax

Practice location:
  • Phone: 510-522-0878
  • Fax: 510-522-0894
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number37095
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number37095
License Number StateCA

VIII. Authorized Official

Name: DR. TERECITA DEAN
Title or Position: OWNER
Credential:
Phone: 510-522-0878