Provider Demographics
NPI:1346625407
Name:ANCHETA, BERNADETTE TESORERO (DDS)
Entity Type:Individual
Prefix:DR
First Name:BERNADETTE
Middle Name:TESORERO
Last Name:ANCHETA
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 1:1117 TANGLEWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-4919
Mailing Address - Country:US
Mailing Address - Phone:650-759-6058
Mailing Address - Fax:
Practice Address - Street 1:1555 WEBSTER ST
Practice Address - Street 2:SUITE B
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-4999
Practice Address - Country:US
Practice Address - Phone:707-673-2570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-29
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64862122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist