Healthcare Provider Details

I. General information

NPI: 1154041168
Provider Name (Legal Business Name): TERI MITCHELL DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2022
Last Update Date: 08/30/2022
Certification Date: 08/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 5TH ST
SAN FRANCISCO CA
94103-2919
US

IV. Provider business mailing address

5450 BACON RD
OAKLAND CA
94619-3164
US

V. Phone/Fax

Practice location:
  • Phone: 415-929-6501
  • Fax:
Mailing address:
  • Phone: 410-501-0846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number107894
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: