Provider Demographics
NPI:1225243991
Name:TETZ, JAMES A (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:A
Last Name:TETZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 E HIGH ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45505-1363
Mailing Address - Country:US
Mailing Address - Phone:937-324-5700
Mailing Address - Fax:
Practice Address - Street 1:2100 E HIGH ST
Practice Address - Street 2:SUITE 105
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45505-1363
Practice Address - Country:US
Practice Address - Phone:937-324-5700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0174311223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics