Provider Demographics
NPI:1992708903
Name:FITZPATRICK, KEVIN THOMAS (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:THOMAS
Last Name:FITZPATRICK
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 CAMINO DEL MAR
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-2507
Mailing Address - Country:US
Mailing Address - Phone:858-755-1197
Mailing Address - Fax:858-755-4233
Practice Address - Street 1:1333 CAMINO DEL MAR
Practice Address - Street 2:
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-2507
Practice Address - Country:US
Practice Address - Phone:858-755-1197
Practice Address - Fax:858-755-4233
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA517291223G0001X
MI29010160691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice