Provider Demographics
NPI:1225045339
Name:FRITCH, CHARLES JOSEPH (DDS)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:JOSEPH
Last Name:FRITCH
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 1:4334 NORTHWEST EXPRESSWAY
Mailing Address - Street 2:SUITE 153
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116
Mailing Address - Country:US
Mailing Address - Phone:405-946-1479
Mailing Address - Fax:405-286-1622
Practice Address - Street 1:4334 NW EXPRESSWAY
Practice Address - Street 2:SUITE 153
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-1578
Practice Address - Country:US
Practice Address - Phone:405-946-1479
Practice Address - Fax:405-286-1622
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK50161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice