Provider Demographics
NPI:1063428969
Name:FRITZ, DOUGLAS B (DDS)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:B
Last Name:FRITZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4850 E. BROADWAY BLVD.
Mailing Address - Street 2:FRONTIER DENTAL
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710
Mailing Address - Country:US
Mailing Address - Phone:520-514-1883
Mailing Address - Fax:520-514-1997
Practice Address - Street 1:4850 E. BROADWAY BLVD.
Practice Address - Street 2:FRONTIER DENTAL
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710
Practice Address - Country:US
Practice Address - Phone:520-514-1883
Practice Address - Fax:520-514-1997
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5939122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ835853Medicaid