Provider Demographics
NPI:1245586205
Name:TETZ, EMMETT L (DDS)
Entity Type:Individual
Prefix:DR
First Name:EMMETT
Middle Name:L
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 1:3663 SOLANO AVE APT 235
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-2780
Mailing Address - Country:US
Mailing Address - Phone:707-695-9066
Mailing Address - Fax:
Practice Address - Street 1:3663 SOLANO AVE APT 235
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-2780
Practice Address - Country:US
Practice Address - Phone:707-695-9066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-27
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA615981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice