Provider Demographics
NPI:1457340861
Name:KREITZER, MARY HELEN (DMD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:HELEN
Last Name:KREITZER
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 1:123 DWIGHT RD
Mailing Address - Street 2:
Mailing Address - City:LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01106-1748
Mailing Address - Country:US
Mailing Address - Phone:413-567-9495
Mailing Address - Fax:413-565-2785
Practice Address - Street 1:123 DWIGHT RD
Practice Address - Street 2:
Practice Address - City:LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01106-1748
Practice Address - Country:US
Practice Address - Phone:413-567-9495
Practice Address - Fax:413-565-2785
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA144211223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAT57225Medicare UPIN