Provider Demographics
NPI:1588874028
Name:JAMES E. FITZGERALD, DDS INC
Entity type:Organization
Organization Name:JAMES E. FITZGERALD, DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:FITZGERALD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:415-468-5353
Mailing Address - Street 1:100 OLD COUNTY ROAD
Mailing Address - Street 2:STE 100B
Mailing Address - City:BRISBANE
Mailing Address - State:CA
Mailing Address - Zip Code:94005
Mailing Address - Country:US
Mailing Address - Phone:415-468-5353
Mailing Address - Fax:
Practice Address - Street 1:100 OLD COUNTY ROAD
Practice Address - Street 2:STE 100B
Practice Address - City:BRISBANE
Practice Address - State:CA
Practice Address - Zip Code:94005
Practice Address - Country:US
Practice Address - Phone:415-468-5353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29148261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental