Provider Demographics
NPI:1801159371
Name:MITAL SPATZ DDS PC
Entity type:Organization
Organization Name:MITAL SPATZ DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MITAL
Authorized Official - Middle Name:
Authorized Official - Last Name:SPATZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-908-0482
Mailing Address - Street 1:1474 W FOSTER AVE
Mailing Address - Street 2:1E
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-2145
Mailing Address - Country:US
Mailing Address - Phone:773-908-0482
Mailing Address - Fax:
Practice Address - Street 1:1474 W FOSTER AVE
Practice Address - Street 2:1E
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-2145
Practice Address - Country:US
Practice Address - Phone:773-908-0482
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190282951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty