Provider Demographics
NPI:1376111856
Name:AHLFIELD, TERESA (RDH)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:AHLFIELD
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:
Other - Last Name:KOEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDA
Mailing Address - Street 1:7790 YESAL AVE
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-5280
Mailing Address - Country:US
Mailing Address - Phone:805-674-1161
Mailing Address - Fax:
Practice Address - Street 1:7790 YESAL AVE
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-5280
Practice Address - Country:US
Practice Address - Phone:805-674-1161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-11
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32952124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist