Provider Demographics
NPI:1720537434
Name:ZITTERICH, MARISA ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARISA
Middle Name:ANN
Last Name:ZITTERICH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 GATEWAY BOULEVARD NORTH
Mailing Address - Street 2:APT 2109
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126
Mailing Address - Country:US
Mailing Address - Phone:972-342-4091
Mailing Address - Fax:
Practice Address - Street 1:1020 W RALPH HALL PKWY
Practice Address - Street 2:STE 101
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-8710
Practice Address - Country:US
Practice Address - Phone:972-771-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32173122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist