Provider Demographics
NPI:1881742567
Name:LETIZIA, JOHN FRANK (DMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:FRANK
Last Name:LETIZIA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:393 14TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-5110
Mailing Address - Country:US
Mailing Address - Phone:212-410-3909
Mailing Address - Fax:212-426-8362
Practice Address - Street 1:247 E 116TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-1402
Practice Address - Country:US
Practice Address - Phone:212-410-3909
Practice Address - Fax:212-426-8362
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042037-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice