Provider Demographics
NPI:1558652396
Name:SULITZER, JEFFREY A (DMD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:A
Last Name:SULITZER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1037 E PALMDALE BLVD STE 203
Mailing Address - Street 2:
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 STE 203
Practice Address - Street 2:
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
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-27
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA518411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA18391OtherPACIFICARE
CAF2989OtherGOLDEN WEST
CA004802OtherLIBERTY DENTAL
CA556327OtherANTHEM BLUE CROSS
CAG9303001Medicaid
CA1625795OtherUNITED CONCORDIA
CAG98402-01OtherDELTA HEALTHY FAMILIES
CA8108OtherSAFEGUARD
CA13059OtherPACIFIC UNION
CA5169OtherMANAGED DENTAL CARE