Dr. John W Etzenbach, DDS
Dentist, Periodontics in Tripler Amc, HI. Individual provider (NPI-1).
NPI number1790740322
StatusActive
Last updated in NPPESFeb 5, 2015
Details
- NPI
- 1790740322
- Entity type
- Individual (NPI-1)
- Name
- Dr. John W Etzenbach
- Credential
- DDS
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Apr 18, 2006
- Last updated
- Feb 5, 2015
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223P0300X | Dentist, Periodontics | 2192 | HI | Yes |
| 1223P0300X | Dentist, Periodontics | 52815 | CA | |
| 1223P0300X | Dentist, Periodontics | 019018177 | IL |
Practice location
1 Jarrett White Rd Bldg 320Us Army Dental Activity
Tripler Amc, HI 96859-5001
Phone 808-433-9200 · Fax 808-433-9194
Mailing address
1 Jarrett White Rd Bldg 320Us Army Dental Activity
Tripler Amc, HI 96859-5001
Phone 808-433-9200 · Fax 808-433-9194
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