Provider Demographics
NPI:1699870733
Name:TERO, MARIE ANGELINE (DDS)
Entity type:Individual
Prefix:DR
First Name:MARIE
Middle Name:ANGELINE
Last Name:TERO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MARIE
Other - Middle Name:TERO
Other - Last Name:CHANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:231 ENCOUNTER BAY
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94502-7909
Mailing Address - Country:US
Mailing Address - Phone:510-772-6392
Mailing Address - Fax:
Practice Address - Street 1:680 BANCROFT AVE
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-2904
Practice Address - Country:US
Practice Address - Phone:510-569-0218
Practice Address - Fax:510-569-9714
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA456211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice