Individual
STEPHANIE M LITZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS, MSD
Contact information
Practice address
100 TOWN CENTER DR S STE A, MOORESVILLE, IN 46158-2322
(317) 831-5439
(317) 831-9750
Mailing address
124 N INDIANA ST, MOORESVILLE, IN 46158-1503
(317) 831-3370
(317) 834-1012
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
12009130
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100186730A
—
IN
05
—
300046440
—
IN
Enumeration date
04/25/2007
Last updated
12/03/2021
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