Provider Demographics
NPI:1487206934
Name:VETTER, ERIC (DMD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:VETTER
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 1:299 QUAIL ST
Mailing Address - Street 2:
Mailing Address - City:VAN
Mailing Address - State:TX
Mailing Address - Zip Code:75790-3841
Mailing Address - Country:US
Mailing Address - Phone:903-963-8681
Mailing Address - Fax:
Practice Address - Street 1:444 FOREST SQ STE E
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-4463
Practice Address - Country:US
Practice Address - Phone:903-758-5551
Practice Address - Fax:903-758-5877
Is Sole Proprietor?:No
Enumeration Date:2019-07-15
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35264122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist