Provider Demographics
NPI:1437478211
Name:EUSEBIO, TEODORO ESPIRITU (DMD)
Entity Type:Individual
Prefix:DR
First Name:TEODORO
Middle Name:ESPIRITU
Last Name:EUSEBIO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1242 PARK ST.
Mailing Address - Street 2:SUITE #A
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501
Mailing Address - Country:US
Mailing Address - Phone:510-865-6890
Mailing Address - Fax:510-865-6844
Practice Address - Street 1:1242 PARK ST STE A
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-5500
Practice Address - Country:US
Practice Address - Phone:510-865-6890
Practice Address - Fax:510-865-6844
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-19
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA376591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice