Provider Demographics
NPI:1629152756
Name:POLITZ, DALE J SR (DDS)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:J
Last Name:POLITZ
Suffix:SR
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:DALE
Other - Middle Name:J
Other - Last Name:POLITZ
Other - Suffix:SR
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:7707 OLD HAMMOND HWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-1262
Mailing Address - Country:US
Mailing Address - Phone:225-926-6899
Mailing Address - Fax:225-926-7315
Practice Address - Street 1:7707 OLD HAMMOND HWY
Practice Address - Street 2:SUITE B
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-1262
Practice Address - Country:US
Practice Address - Phone:225-926-6899
Practice Address - Fax:225-926-7315
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA45791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice