Provider Demographics
NPI:1437204070
Name:JEFFREY A. SULITZER, DMD, INC
Entity Type:Organization
Organization Name:JEFFREY A. SULITZER, DMD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SULITZER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:661-272-9181
Mailing Address - Street 1:1037 E PALMDALE BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93550-4745
Mailing Address - Country:US
Mailing Address - Phone:661-272-9181
Mailing Address - Fax:661-272-8932
Practice Address - Street 1:1037 E PALMDALE BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-4745
Practice Address - Country:US
Practice Address - Phone:661-272-9181
Practice Address - Fax:661-272-8932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD518411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1625795OtherUNITED CONCORDIA
CA8108OtherSAFEGUARD
CAF2989OtherGOLDEN WEST
CAG93030-01Medicaid
CA13059OtherPACIFIC UNION
CA004802OtherLIBERTY DENTAL
CA18391OtherPACIFIC CARE
CA5169OtherMANAGED DENTAL CARE
CA556327OtherBLUE CROSS
CAG98402-01OtherDELTA HEALTHY FAMILIES