Provider Demographics
NPI:1376701672
Name:TETRICK, THOMAS N (DDS)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:N
Last Name:TETRICK
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 1:5140 S 56TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-1832
Mailing Address - Country:US
Mailing Address - Phone:402-423-1100
Mailing Address - Fax:
Practice Address - Street 1:5140 S 56TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-1832
Practice Address - Country:US
Practice Address - Phone:402-423-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5644122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist