Provider Demographics
NPI:1700556099
Name:BRUCE VETTERS D.D.S. INC
Entity Type:Organization
Organization Name:BRUCE VETTERS D.D.S. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:L
Authorized Official - Last Name:VETTERS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-924-1066
Mailing Address - Street 1:6619 S FLORES ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78214-2629
Mailing Address - Country:US
Mailing Address - Phone:210-924-1066
Mailing Address - Fax:210-924-1093
Practice Address - Street 1:6619 S FLORES ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78214-2629
Practice Address - Country:US
Practice Address - Phone:210-924-1066
Practice Address - Fax:210-924-1093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-17
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty