Provider Demographics
NPI:1215023452
Name:MICHAEL R ZEITLER DDS LLC
Entity type:Organization
Organization Name:MICHAEL R ZEITLER DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:ZEITLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:219-464-9681
Mailing Address - Street 1:809 WALL STREET
Mailing Address - Street 2:
Mailing Address - City:VALPARISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-2516
Mailing Address - Country:US
Mailing Address - Phone:219-464-9681
Mailing Address - Fax:219-464-9682
Practice Address - Street 1:809 WALL STREET
Practice Address - Street 2:
Practice Address - City:VALPARISO
Practice Address - State:IN
Practice Address - Zip Code:46383-2516
Practice Address - Country:US
Practice Address - Phone:219-464-9681
Practice Address - Fax:219-464-9682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009162A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty