Healthcare Provider Details

I. General information

NPI: 1053471037
Provider Name (Legal Business Name): PHILIP TETZ D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 10/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8008 WEST AVE SUITE #1
CASTLE HILLS TX
78213-1872
US

IV. Provider business mailing address

8008 WEST AVE STE 1
CASTLE HILLS TX
78213-1872
US

V. Phone/Fax

Practice location:
  • Phone: 210-231-0430
  • Fax: 210-231-0675
Mailing address:
  • Phone: 210-231-0430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number18397
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: