Provider Demographics
NPI:1558519991
Name:TERAMURA, MATT (DMD)
Entity Type:Individual
Prefix:DR
First Name:MATT
Middle Name:
Last Name:TERAMURA
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 1:500 E REMINGTON DR STE 19
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-2611
Mailing Address - Country:US
Mailing Address - Phone:408-749-9888
Mailing Address - Fax:408-749-9289
Practice Address - Street 1:500 E REMINGTON DR STE 19
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-2611
Practice Address - Country:US
Practice Address - Phone:408-749-9888
Practice Address - Fax:408-749-9289
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-27
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52941122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist