MEDICARE: LITZA MARIA LEFEBRE DORTA DMD

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	1223G0001X	General Practice Dentistry	31971	TX

General Provider Information

NPI Number	:	1710339049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LITZA MARIA LEFEBRE DORTA DMD

Provider Business Mailing Address
First Line	:	12501 HYMEADOW DR
Second Line	:	#1A
City	:	AUSTIN
State	:	TX
Zip	:	78750-2263
Country	:	US
Telephone Number	:	786-728-5242
Fax Number	:

Provider Business Practice Location Address
First Line	:	12501 HYMEADOW DR
Second Line	:	#1A
City	:	AUSTIN
State	:	TX
Zip	:	78750-2263
Country	:	US
Telephone Number	:	786-728-5242
Fax Number	:

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

Provider Enumeration Date	:	07/11/2016
Last Update Date	:	07/11/2016

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