Provider Demographics
NPI:1528154168
Name:LETIZIA, THOMAS L (DDS, MAGD, FICOI, PA)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:L
Last Name:LETIZIA
Suffix:
Gender:M
Credentials:DDS, MAGD, FICOI, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 EAST BLACK HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08232-2759
Mailing Address - Country:US
Mailing Address - Phone:609-646-1231
Mailing Address - Fax:609-272-9783
Practice Address - Street 1:49 EAST BLACK HORSE PIKE
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08232-2759
Practice Address - Country:US
Practice Address - Phone:609-646-1231
Practice Address - Fax:609-272-9783
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI00866001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice