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General NPI Number Information
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NPI Number | 1073822490
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Entity Type | Organization
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Legal Business Name | JACK S. LITZ, D.D.S., LTD.
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Dates
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Enumeration Date | 10/04/2010
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Last Update Date | 10/04/2010
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Provider Practice Location Address
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Address Line | 6435 S PULASKI RD
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City | CHICAGO
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State | IL
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Zip | 60629-5148
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Country | US
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Telephone | 773-735-2515
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Fax |
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Provider Business Mailing Address
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Address Line | 6435 S PULASKI RD
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City | CHICAGO
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State | IL
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Zip | 60629-5148
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Country | US
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Telephone | 773-735-2515
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JACK S. LITZ
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Credential | D.D.S.
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Telephone | 773-735-2515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 01912745
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License Number State | IN
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