Provider Demographics
NPI:1740374297
Name:THOMAS L. LETIZIA, DDS, PA
Entity type:Organization
Organization Name:THOMAS L. LETIZIA, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:LETIZIA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MAGD, FICOI, PA
Authorized Official - Phone:609-646-1231
Mailing Address - Street 1:49 EAST BLACK HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08232-2759
Mailing Address - Country:US
Mailing Address - Phone:609-646-1231
Mailing Address - Fax:609-272-9783
Practice Address - Street 1:49 EAST BLACK HORSE PIKE
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08232-2759
Practice Address - Country:US
Practice Address - Phone:609-646-1231
Practice Address - Fax:609-272-9783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI00866001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty