MEDICARE: DR. GRANT STEVEN TITZE DDS PC

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
1	122300000X	Dentist	M590	SD

General Provider Information

NPI Number	:	1538207758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GRANT STEVEN TITZE DDS PC

Provider Business Mailing Address
First Line	:	20 19TH ST SE
Second Line	:
City	:	WATERTOWN
State	:	SD
Zip	:	57201-3938
Country	:	US
Telephone Number	:	605-886-2805
Fax Number	:	605-886-8357

Provider Business Practice Location Address
First Line	:	20 19TH ST SE
Second Line	:
City	:	WATERTOWN
State	:	SD
Zip	:	57201-3938
Country	:	US
Telephone Number	:	605-886-2805
Fax Number	:	605-886-8357

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	05/17/2021

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