Provider Demographics
NPI:1871625467
Name:HARADA, TERU (DDS)
Entity type:Individual
Prefix:DR
First Name:TERU
Middle Name:
Last Name:HARADA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2421 PARK BLVD
Mailing Address - Street 2:#205
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-1998
Mailing Address - Country:US
Mailing Address - Phone:650-321-8731
Mailing Address - Fax:650-321-3866
Practice Address - Street 1:2421 PARK BLVD
Practice Address - Street 2:#205
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-1998
Practice Address - Country:US
Practice Address - Phone:650-321-8731
Practice Address - Fax:650-321-3866
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA276261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice