Provider Demographics
NPI:1184766784
Name:BIANCHI, TERI JEANNIEN (DDS)
Entity type:Individual
Prefix:DR
First Name:TERI
Middle Name:JEANNIEN
Last Name:BIANCHI
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 1:310 UPPER LAKE RD
Mailing Address - Street 2:
Mailing Address - City:LAKE SHERWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91361-5143
Mailing Address - Country:US
Mailing Address - Phone:805-427-6033
Mailing Address - Fax:
Practice Address - Street 1:310 UPPER LAKE RD
Practice Address - Street 2:
Practice Address - City:LAKE SHERWOOD
Practice Address - State:CA
Practice Address - Zip Code:91361
Practice Address - Country:US
Practice Address - Phone:805-427-6033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42722122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist