Provider Demographics
NPI:1720192669
Name:ALTIZER, STANLEY A (DDS)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:A
Last Name:ALTIZER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7500 TOWN CENTRE DR
Mailing Address - Street 2:STE 100
Mailing Address - City:BROADVIEW HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44147-4048
Mailing Address - Country:US
Mailing Address - Phone:440-526-7277
Mailing Address - Fax:440-526-0320
Practice Address - Street 1:7500 TOWN CENTRE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:BROADVIEW HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44147-4009
Practice Address - Country:US
Practice Address - Phone:440-526-7277
Practice Address - Fax:440-526-0320
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH177241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice