MEDICARE: DR. PHILIP TETZ D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	18397	TX

General Provider Information

NPI Number	:	1053471037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILIP TETZ D.D.S.

Provider Business Mailing Address
First Line	:	8008 WEST AVE STE 1
Second Line	:
City	:	CASTLE HILLS
State	:	TX
Zip	:	78213-1872
Country	:	US
Telephone Number	:	210-231-0430
Fax Number	:

Provider Business Practice Location Address
First Line	:	8008 WEST AVE
Second Line	:	SUITE #1
City	:	CASTLE HILLS
State	:	TX
Zip	:	78213-1872
Country	:	US
Telephone Number	:	210-231-0430
Fax Number	:	210-231-0675

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	10/14/2008

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