Provider Demographics
NPI:1124180922
Name:FASSLER, ELIZABETH REITZ (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:REITZ
Last Name:FASSLER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 W. MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028
Mailing Address - Country:US
Mailing Address - Phone:636-937-5118
Mailing Address - Fax:636-937-3643
Practice Address - Street 1:110 SOUTH 2ND ST
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-2201
Practice Address - Country:US
Practice Address - Phone:636-937-5118
Practice Address - Fax:636-937-3643
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0155591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice