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Individual
DR. JOHN W ETZENBACH
Active
Individual
DR. JOHN W ETZENBACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
019018177
IL
1223P0300X
Periodontics
Primary
2192
HI
1223P0300X
Periodontics
52815
CA
Other
Enumeration date
04/18/2006
Last updated
02/05/2015
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