Provider Demographics
NPI:1952696486
Name:VAN HOUTEN, TERA LYNN (DDS)
Entity Type:Individual
Prefix:DR
First Name:TERA
Middle Name:LYNN
Last Name:VAN HOUTEN
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 1:224 43RD ST # A
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-3009
Mailing Address - Country:US
Mailing Address - Phone:310-775-0645
Mailing Address - Fax:
Practice Address - Street 1:1235 W HUNTINGTON DR STE A
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-6382
Practice Address - Country:US
Practice Address - Phone:626-449-8963
Practice Address - Fax:626-449-5716
Is Sole Proprietor?:No
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA579871223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry