Healthcare Provider Details

I. General information

NPI: 1659206159
Provider Name (Legal Business Name): ETHAN PAUL TETTING DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 TRI PARK WAY
APPLETON WI
54914-1661
US

IV. Provider business mailing address

2141 N MCCARTHY RD APT 2
APPLETON WI
54913-9063
US

V. Phone/Fax

Practice location:
  • Phone: 920-882-5500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number600222115
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: