Provider Demographics
NPI:1417961400
Name:TETZNER, EMIL WILLIAM (DMD MS)
Entity Type:Individual
Prefix:DR
First Name:EMIL
Middle Name:WILLIAM
Last Name:TETZNER
Suffix:
Gender:M
Credentials:DMD MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-4123
Mailing Address - Country:US
Mailing Address - Phone:302-744-9900
Mailing Address - Fax:302-744-9902
Practice Address - Street 1:804 S STATE ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-4123
Practice Address - Country:US
Practice Address - Phone:302-744-9900
Practice Address - Fax:302-744-9902
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG100010221223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
617755OtherUNITED CONCORDIA INS
DE1000033719Medicaid