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General NPI Number Information
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NPI Number | 1952400434
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Entity Type | Individual
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Provider Name | RONALD GENE TIETZ DDS
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Gender | Male
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 01/29/2009
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Provider Practice Location Address
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Address Line | 7700 BROADWAY ST STE 100B
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City | SAN ANTONIO
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State | TX
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Zip | 78209-3260
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Country | US
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Telephone | 210-824-2333
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Fax | 210-824-0680
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Provider Business Mailing Address
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Address Line | 7700 BROADWAY ST STE 100B
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City | SAN ANTONIO
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State | TX
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Zip | 78209-3260
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Country | US
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Telephone | 210-824-2333
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Fax | 210-824-0680
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 9396
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License Number State | TX
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