Healthcare Provider Details

I. General information

NPI: 1639320765
Provider Name (Legal Business Name): JOHN DAVID TEEPE D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2008
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 41 BOX 1575
APO AE
09464-0016
US

IV. Provider business mailing address

48TH MDG/RAF LAKENHEATH
APO AE
09461
US

V. Phone/Fax

Practice location:
  • Phone: 402-630-2170
  • Fax:
Mailing address:
  • Phone: 402-630-2170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number24229
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: