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General NPI Number Information
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NPI Number | 1740374297
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Entity Type | Organization
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Legal Business Name | THOMAS L. LETIZIA, DDS, PA
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 09/20/2010
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Provider Practice Location Address
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Address Line | 49 EAST BLACK HORSE PIKE
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City | PLEASANTVILLE
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State | NJ
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Zip | 08232-2759
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Country | US
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Telephone | 609-646-1231
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Fax | 609-272-9783
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Provider Business Mailing Address
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Address Line | 49 EAST BLACK HORSE PIKE
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City | PLEASANTVILLE
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State | NJ
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Zip | 08232-2759
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Country | US
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Telephone | 609-646-1231
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Fax | 609-272-9783
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Authorized Official
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Title or Position | DENTIST
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Name | DR. THOMAS L LETIZIA
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Credential | DDS, MAGD, FICOI, PA
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Telephone | 609-646-1231
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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 | 22DI0086600
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License Number State | NJ
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