Provider Demographics
NPI:1386650307
Name:TERASAKI, RICHARD MATTHEW (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:MATTHEW
Last Name:TERASAKI
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 1:1606 N VIRGINIA ST
Mailing Address - Street 2:
Mailing Address - City:PORT LAVACA
Mailing Address - State:TX
Mailing Address - Zip Code:77979-2241
Mailing Address - Country:US
Mailing Address - Phone:361-552-5800
Mailing Address - Fax:888-276-1646
Practice Address - Street 1:1606 N VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:PORT LAVACA
Practice Address - State:TX
Practice Address - Zip Code:77979-2241
Practice Address - Country:US
Practice Address - Phone:361-552-5800
Practice Address - Fax:888-276-1646
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12390122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist