Individual
SEBASTIAN TIETZE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
716 S HWY 77, NEWKIRK746, OK 74647-5525
(580) 362-2555
(580) 362-2948
Mailing address
212 N MAIN ST, FAIRFAX, OK 74637-3023
(918) 642-3100
(918) 642-5639
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6447
OK
Other
Enumeration date
10/02/2012
Last updated
06/07/2013
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