MEDICARE: ZETH JURICH DMD

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	39689	TX

General Provider Information

NPI Number	:	1275218208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZETH JURICH DMD

Provider Business Mailing Address
First Line	:	21375 COUNTY ROAD 174
Second Line	:
City	:	HELOTES
State	:	TX
Zip	:	78023-2409
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1804 BUENA VISTA ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78207-3805
Country	:	US
Telephone Number	:	210-227-9921
Fax Number	:	210-223-4081

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

Provider Enumeration Date	:	06/19/2023
Last Update Date	:	10/28/2024

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