Provider Demographics
NPI:1053692368
Name:GATESVILLE FAMILY DENTAL, ,P.C.
Entity type:Organization
Organization Name:GATESVILLE FAMILY DENTAL, ,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:SPITZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-865-7272
Mailing Address - Street 1:220 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:GATESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76528-1029
Mailing Address - Country:US
Mailing Address - Phone:254-865-7272
Mailing Address - Fax:254-865-6939
Practice Address - Street 1:220 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:GATESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76528-1029
Practice Address - Country:US
Practice Address - Phone:254-865-7272
Practice Address - Fax:254-865-6939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty