Provider Demographics
NPI:1407188105
Name:TESCH, SANDRA LEE (RDH)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:LEE
Last Name:TESCH
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 CLEARWATER CIR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78753-2404
Mailing Address - Country:US
Mailing Address - Phone:512-837-4140
Mailing Address - Fax:512-837-4140
Practice Address - Street 1:902 CLEARWATER CIR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78753-2404
Practice Address - Country:US
Practice Address - Phone:512-837-4140
Practice Address - Fax:512-837-4140
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-04
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5675124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist