Provider Demographics
NPI:1710024922
Name:COSTALES-TEOTICO, ANGELITA U (DDS)
Entity Type:Individual
Prefix:
First Name:ANGELITA
Middle Name:U
Last Name:COSTALES-TEOTICO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7311 MISSION ST
Mailing Address - Street 2:SUITE K
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94014-2657
Mailing Address - Country:US
Mailing Address - Phone:650-757-9497
Mailing Address - Fax:650-757-0103
Practice Address - Street 1:7311 MISSION ST
Practice Address - Street 2:SUITE K
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94014-2657
Practice Address - Country:US
Practice Address - Phone:650-757-9497
Practice Address - Fax:650-757-0103
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA411701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice