Provider Demographics
NPI:1053551002
Name:FITZGERALD DENTAL ASSOCIATES, PC
Entity type:Organization
Organization Name:FITZGERALD DENTAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:FITZGERALD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:724-294-0011
Mailing Address - Street 1:270 BUFFALO PLZ
Mailing Address - Street 2:
Mailing Address - City:SARVER
Mailing Address - State:PA
Mailing Address - Zip Code:16055-8302
Mailing Address - Country:US
Mailing Address - Phone:724-294-0011
Mailing Address - Fax:724-294-2811
Practice Address - Street 1:270 BUFFALO PLZ
Practice Address - Street 2:
Practice Address - City:SARVER
Practice Address - State:PA
Practice Address - Zip Code:16055-8302
Practice Address - Country:US
Practice Address - Phone:724-294-0011
Practice Address - Fax:724-294-2811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-04
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty