Provider Demographics
NPI:1710339049
Name:LEFEBRE DORTA, LITZA MARIA (DMD)
Entity Type:Individual
Prefix:
First Name:LITZA
Middle Name:MARIA
Last Name:LEFEBRE DORTA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12501 HYMEADOW DR
Mailing Address - Street 2:#1A
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-2263
Mailing Address - Country:US
Mailing Address - Phone:786-728-5242
Mailing Address - Fax:
Practice Address - Street 1:12501 HYMEADOW DR
Practice Address - Street 2:#1A
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-2263
Practice Address - Country:US
Practice Address - Phone:786-728-5242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX319711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice