Provider Demographics
NPI:1720297005
Name:FITZGERALD, JAMES PATRICK (DMD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:PATRICK
Last Name:FITZGERALD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 SOUTH STREET
Mailing Address - Street 2:P.O. BOX 545
Mailing Address - City:SOMERS
Mailing Address - State:CT
Mailing Address - Zip Code:06071
Mailing Address - Country:US
Mailing Address - Phone:860-749-0781
Mailing Address - Fax:
Practice Address - Street 1:48 SOUTH RD
Practice Address - Street 2:
Practice Address - City:SOMERS
Practice Address - State:CT
Practice Address - Zip Code:06071-2160
Practice Address - Country:US
Practice Address - Phone:860-749-0781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT089171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice