MEDICARE: DR. BRUCE LEE VETTERS 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	122300000X	Dentist	12083	TX

General Provider Information

NPI Number	:	1881805653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRUCE LEE VETTERS DDS

Provider Business Mailing Address
First Line	:	6619 S FLORES
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78214
Country	:	US
Telephone Number	:	210-924-1066
Fax Number	:	210-924-1093

Provider Business Practice Location Address
First Line	:	6619 S FLORES
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78214
Country	:	US
Telephone Number	:	210-924-1066
Fax Number	:	210-924-1093

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

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	07/08/2007

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