Provider Demographics
NPI:1265652499
Name:TEETERS, KAREN ANNETTE (DDS)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:ANNETTE
Last Name:TEETERS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6520 N 7TH AVE
Mailing Address - Street 2:#3
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013
Mailing Address - Country:US
Mailing Address - Phone:602-249-1666
Mailing Address - Fax:602-249-1777
Practice Address - Street 1:6520 N 7TH AVE
Practice Address - Street 2:#3
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013
Practice Address - Country:US
Practice Address - Phone:602-249-1666
Practice Address - Fax:602-249-1777
Is Sole Proprietor?:No
Enumeration Date:2007-04-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ45301223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ324533OtherAHCCCS