Provider Demographics
NPI:1699072892
Name:WALI, TEENA (DDS)
Entity type:Individual
Prefix:DR
First Name:TEENA
Middle Name:
Last Name:WALI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1937 DANA PL
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-1216
Mailing Address - Country:US
Mailing Address - Phone:412-298-5460
Mailing Address - Fax:
Practice Address - Street 1:1281 E LA HABRA BLVD
Practice Address - Street 2:
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-5600
Practice Address - Country:US
Practice Address - Phone:562-697-3788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-24
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107082122300000X
PADS038418122300000X
MD16614122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist