1972601201 NPI number — ELIZABETH R FASSLER DDS PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972601201 NPI number — ELIZABETH R FASSLER DDS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELIZABETH R FASSLER DDS PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972601201
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
110 SOUTH 2ND ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FESTUS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63028
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-937-5118
Provider Business Mailing Address Fax Number:
636-937-3643

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 SOUTH 2ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FESTUS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63028
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-937-5118
Provider Business Practice Location Address Fax Number:
636-937-3643
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FASSLER
Authorized Official First Name:
ELIZABETH
Authorized Official Middle Name:
REITZ
Authorized Official Title or Position:
OWNER DENTIST
Authorized Official Telephone Number:
636-937-5118

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  D15559 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2026 www.npivalidator.com