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General NPI Number Information
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NPI Number | 1972601201
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Entity Type | Organization
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Legal Business Name | ELIZABETH R FASSLER DDS PC
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 08/22/2020
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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
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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 | 110 SOUTH 2ND 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 | OWNER DENTIST
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Name | DR. ELIZABETH REITZ FASSLER
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Credential | DDS
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Telephone | 636-937-5118
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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 | D15559
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License Number State | MO
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