MEDICARE: DR. NATHAN HETRICK DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	38560	TX

General Provider Information

NPI Number	:	1588396832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NATHAN HETRICK DDS

Provider Business Mailing Address
First Line	:	9590 MARBACH RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78245-1825
Country	:	US
Telephone Number	:	210-673-9051
Fax Number	:

Provider Business Practice Location Address
First Line	:	9590 MARBACH RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78245-1825
Country	:	US
Telephone Number	:	210-673-9051
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2022
Last Update Date	:	10/05/2022

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Directions to “ DR. NATHAN HETRICK DDS” Practice Location

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