Provider Demographics
NPI:1053471037
Name:TETZ, PHILIP (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:
Last Name:TETZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8008 WEST AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:CASTLE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78213-1872
Mailing Address - Country:US
Mailing Address - Phone:210-231-0430
Mailing Address - Fax:
Practice Address - Street 1:8008 WEST AVE
Practice Address - Street 2:SUITE #1
Practice Address - City:CASTLE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78213-1872
Practice Address - Country:US
Practice Address - Phone:210-231-0430
Practice Address - Fax:210-231-0675
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX183971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice