Provider Demographics
NPI:1891324026
Name:TETZ & VARLAKOVA DENTAL CORPORATION
Entity Type:Organization
Organization Name:TETZ & VARLAKOVA DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EMMETT
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:TETZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:707-963-5369
Mailing Address - Street 1:748 SUNNYSIDE RD
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENA
Mailing Address - State:CA
Mailing Address - Zip Code:94574-9741
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1570 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:SAINT HELENA
Practice Address - State:CA
Practice Address - Zip Code:94574-1106
Practice Address - Country:US
Practice Address - Phone:707-963-5369
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA61598OtherDENTAL LICENSE
FT3400784OtherDEA