Provider Demographics
NPI:1912605163
Name:FAMILY DENTISTRY OF LITITZ LLC
Entity Type:Organization
Organization Name:FAMILY DENTISTRY OF LITITZ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:M
Authorized Official - Last Name:TUNO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-581-9191
Mailing Address - Street 1:1325 BRIGHTON AVE STE 7
Mailing Address - Street 2:
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543-6505
Mailing Address - Country:US
Mailing Address - Phone:717-581-9191
Mailing Address - Fax:
Practice Address - Street 1:1325 BRIGHTON AVE STE 7
Practice Address - Street 2:
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543-6505
Practice Address - Country:US
Practice Address - Phone:717-581-9191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-17
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental