Provider Demographics
NPI:1205266269
Name:MATTHEW J. TERAMURA DMD INC.
Entity type:Organization
Organization Name:MATTHEW J. TERAMURA DMD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:J
Authorized Official - Last Name:TERAMURA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:415-215-5792
Mailing Address - Street 1:326 VIA ROSARIO
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-5322
Mailing Address - Country:US
Mailing Address - Phone:415-215-5792
Mailing Address - Fax:
Practice Address - Street 1:4949 STEVENSON BLVD STE J
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-2572
Practice Address - Country:US
Practice Address - Phone:510-574-5330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-12
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA529411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty