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NPI Code Detail

MEDICARE: DR. MITAL SPATZ DDS

MEDICARE: DR. MITAL SPATZ DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist019028295IL
21223P0221XPediatric Dentistry021002694IL

General Provider Information

NPI Number : 1134449747
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MITAL SPATZ DDS
Provider Business Mailing Address
First Line : 2929 N. SOUTHPORT AVE
Second Line : TOOTH BUDS PEDIATRIC DENTISTRY
City : CHICAGO
State : IL
Zip : 60657
Country : US
Telephone Number : 773-328-8282
Fax Number : 773-328-8402
Provider Business Practice Location Address
First Line : 2929 N SOUTHPORT AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60657-6945
Country : US
Telephone Number : 773-328-8282
Fax Number : 773-328-8204
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/04/2010
Last Update Date : 05/03/2018

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Directions to “ DR. MITAL SPATZ DDS” Practice Location

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