Provider Demographics
NPI:1053042549
Name:KAUTZ, TEAH MARIE
Entity Type:Individual
Prefix:
First Name:TEAH
Middle Name:MARIE
Last Name:KAUTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 S SAN FRANCISCO ST APT 804D
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-0507
Mailing Address - Country:US
Mailing Address - Phone:530-845-3044
Mailing Address - Fax:
Practice Address - Street 1:NAU DEPARTMENT OF DENTAL HYGIENE 208 E PINE KNOLL DRIVE
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86011-0001
Practice Address - Country:US
Practice Address - Phone:928-523-5122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist