Provider Demographics
NPI:1568844785
Name:STEPHANIE LITZ DDS, PC
Entity Type:Organization
Organization Name:STEPHANIE LITZ DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-831-3370
Mailing Address - Street 1:124 N INDIANA ST
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46158-1503
Mailing Address - Country:US
Mailing Address - Phone:317-831-3370
Mailing Address - Fax:317-834-6704
Practice Address - Street 1:124 N INDIANA ST
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46158-1503
Practice Address - Country:US
Practice Address - Phone:317-831-3370
Practice Address - Fax:317-831-3370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-24
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120091301223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100186730Medicaid