Provider Demographics
NPI:1295851343
Name:TERANISHI, PAUL A (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:A
Last Name:TERANISHI
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 1:612 W 11TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-3859
Mailing Address - Country:US
Mailing Address - Phone:209-835-8408
Mailing Address - Fax:209-835-8489
Practice Address - Street 1:612 W 11TH ST STE 201
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-3859
Practice Address - Country:US
Practice Address - Phone:209-835-8408
Practice Address - Fax:209-835-8489
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA321861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice