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General NPI Number Information
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NPI Number | 1205266269
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Entity Type | Organization
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Legal Business Name | MATTHEW J. TERAMURA DMD INC.
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Dates
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Enumeration Date | 11/12/2013
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Last Update Date | 11/12/2013
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Provider Practice Location Address
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Address Line | 4949 STEVENSON BLVD STE J
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City | FREMONT
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State | CA
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Zip | 94538-2572
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Country | US
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Telephone | 510-574-5330
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Fax |
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Provider Business Mailing Address
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Address Line | 326 VIA ROSARIO
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City | FREMONT
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State | CA
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Zip | 94539-5322
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Country | US
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Telephone | 415-215-5792
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MATTHEW J. TERAMURA
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Credential | DMD
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Telephone | 415-215-5792
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 52941
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License Number State | CA
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