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General NPI Number Information
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NPI Number | 1124180922
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Entity Type | Individual
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Provider Name | ELIZABETH REITZ FASSLER DDS
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Gender | Female
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Dates
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Enumeration Date | 12/15/2006
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Last Update Date | 02/09/2009
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Provider Practice Location Address
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Address Line | 110 SOUTH 2ND ST
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City | FESTUS
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State | MO
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Zip | 63028-2201
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Country | US
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Telephone | 636-937-5118
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Fax | 636-937-3643
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Provider Business Mailing Address
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Address Line | 412 W. MAIN ST.
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City | FESTUS
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State | MO
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Zip | 63028
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Country | US
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Telephone | 636-937-5118
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Fax | 636-937-3643
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 015559
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License Number State | MO
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