Provider Demographics
NPI:1053190009
Name:FITZSIMONDS, ZACKARY RAY (DMD, PHD)
Entity type:Individual
Prefix:DR
First Name:ZACKARY
Middle Name:RAY
Last Name:FITZSIMONDS
Suffix:
Gender:M
Credentials:DMD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28602 TOMBALL PKWY STE B
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-3522
Mailing Address - Country:US
Mailing Address - Phone:615-439-5981
Mailing Address - Fax:
Practice Address - Street 1:28602 TOMBALL PKWY STE B
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-3522
Practice Address - Country:US
Practice Address - Phone:615-439-5981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-27
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901601907122300000X
TX400461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No122300000XDental ProvidersDentist