Provider Demographics
NPI:1174361679
Name:VITZTHUM FAMILY DENTISTRY
Entity type:Organization
Organization Name:VITZTHUM FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:VITZTHUM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:515-890-7989
Mailing Address - Street 1:1866 W RIDGEWAY AVE
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-4546
Mailing Address - Country:US
Mailing Address - Phone:319-235-0164
Mailing Address - Fax:
Practice Address - Street 1:1866 W RIDGEWAY AVE
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-4546
Practice Address - Country:US
Practice Address - Phone:319-235-0164
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1730673146OtherNPPES
IA1063039618OtherNPPES
IA1013447515OtherNPPES
IA1467070060OtherNPPES