Provider Demographics
NPI:1184709743
Name:CHAN, TERESA Y (DDS)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:Y
Last Name:CHAN
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 1:10311 S DE ANZA BLVD
Mailing Address - Street 2:SUITE #3
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-3028
Mailing Address - Country:US
Mailing Address - Phone:408-996-8000
Mailing Address - Fax:408-996-8008
Practice Address - Street 1:10311 S DE ANZA BLVD
Practice Address - Street 2:SUITE #3
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-3028
Practice Address - Country:US
Practice Address - Phone:408-996-8000
Practice Address - Fax:408-996-8008
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA376391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice