Provider Demographics
NPI:1487723730
Name:LITIZZETTE-WITZEL, NICOLE SUZANNE (DDS, MS)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:SUZANNE
Last Name:LITIZZETTE-WITZEL
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 BEE CAVES RD
Mailing Address - Street 2:SUITE C211
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746
Mailing Address - Country:US
Mailing Address - Phone:512-306-8822
Mailing Address - Fax:512-306-8848
Practice Address - Street 1:4201 BEE CAVES RD
Practice Address - Street 2:SUITE C211
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746
Practice Address - Country:US
Practice Address - Phone:512-306-8822
Practice Address - Fax:512-306-8848
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN83491223P0300X
TX243291223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics