Provider Demographics
NPI:1053578591
Name:MATTHEW D. LITZ, D.D.S., LLC
Entity type:Organization
Organization Name:MATTHEW D. LITZ, D.D.S., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:LITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-822-3222
Mailing Address - Street 1:400 CENTURY PARK S
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35226-3945
Mailing Address - Country:US
Mailing Address - Phone:205-822-3222
Mailing Address - Fax:205-822-3504
Practice Address - Street 1:400 CENTURY PARK S
Practice Address - Street 2:SUITE 200
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35226-3945
Practice Address - Country:US
Practice Address - Phone:205-822-3222
Practice Address - Fax:205-822-3504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL55431223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty