Provider Demographics
NPI:1215224407
Name:TEANG, ANTONO (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANTONO
Middle Name:
Last Name:TEANG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 ROSEMEAD BLVD
Mailing Address - Street 2:COAST DENTAL
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-4404
Mailing Address - Country:US
Mailing Address - Phone:626-575-1161
Mailing Address - Fax:
Practice Address - Street 1:4100 ROSEMEAD BLVD
Practice Address - Street 2:COAST DENTAL
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-4404
Practice Address - Country:US
Practice Address - Phone:626-575-1161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-07
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA619161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice