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General NPI Number Information
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NPI Number | 1659980589
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Entity Type | Individual
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Provider Name | WILLIAM JOHN PUETZ III DDS
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Gender | Male
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Dates
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Enumeration Date | 07/27/2020
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Last Update Date | 07/19/2023
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Provider Practice Location Address
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Address Line | 1105 RED TAIL WAY
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City | SIMI VALLEY
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State | CA
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Zip | 93065-7232
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Country | US
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Telephone | 805-577-7733
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Fax |
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Provider Business Mailing Address
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Address Line | 21606 DEVONSHIRE ST # 4356
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City | CHATSWORTH
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State | CA
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Zip | 91311-2901
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Country | US
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Telephone | 917-880-5780
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 105064
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License Number State | CA
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