Provider Demographics
NPI:1871732461
Name:GARY D. KITZIS, DMD PLLC
Entity type:Organization
Organization Name:GARY D. KITZIS, DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:D
Authorized Official - Last Name:KITZIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:516-692-7766
Mailing Address - Street 1:156 PLAINVIEW RD.
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-2807
Mailing Address - Country:US
Mailing Address - Phone:516-692-7766
Mailing Address - Fax:631-692-6129
Practice Address - Street 1:156 PLAINVIEW RD.
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-2807
Practice Address - Country:US
Practice Address - Phone:516-692-7766
Practice Address - Fax:631-692-6129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-05
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036994-11223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty