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General NPI Number Information
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NPI Number | 1831496785
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Entity Type | Organization
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Legal Business Name | TERECITA DEAN, D.D.S.
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Dates
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Enumeration Date | 02/11/2011
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Last Update Date | 02/11/2011
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Provider Practice Location Address
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Address Line | 2017 CENTRAL AVE
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City | ALAMEDA
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State | CA
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Zip | 94501-4210
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Country | US
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Telephone | 510-522-0878
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Fax | 510-522-0894
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Provider Business Mailing Address
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Address Line | 2017 CENTRAL AVE
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City | ALAMEDA
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State | CA
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Zip | 94501-4210
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. TERECITA DEAN
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Credential |
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Telephone | 510-522-0878
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 37095
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | 37095
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License Number State | CA
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