Healthcare Provider Details

I. General information

NPI: 1659980589
Provider Name (Legal Business Name): WILLIAM JOHN PUETZ III DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2020
Last Update Date: 07/19/2023
Certification Date: 07/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 RED TAIL WAY
SIMI VALLEY CA
93065-7232
US

IV. Provider business mailing address

21606 DEVONSHIRE ST # 4356
CHATSWORTH CA
91311-2901
US

V. Phone/Fax

Practice location:
  • Phone: 805-577-7733
  • Fax:
Mailing address:
  • Phone: 917-880-5780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number105064
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: