Provider Demographics
NPI:1407801871
Name:AVENDANO-GALVEZ, TERESA MARTHA (DMD)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:MARTHA
Last Name:AVENDANO-GALVEZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1451 W ARTESIA BLVD
Mailing Address - Street 2:SUITE #6
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90248-3232
Mailing Address - Country:US
Mailing Address - Phone:310-323-0290
Mailing Address - Fax:310-323-7670
Practice Address - Street 1:1451 W ARTESIA BLVD
Practice Address - Street 2:SUITE #6
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90248-3232
Practice Address - Country:US
Practice Address - Phone:310-323-0290
Practice Address - Fax:310-323-7670
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA370791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB37079-01OtherDENTI-CAL