Provider Demographics
NPI:1003218991
Name:FITZGERALD, SEAN EDWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:EDWARD
Last Name:FITZGERALD
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 1:18700 W LAKE HOUSTON PKWY STE A107
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-3350
Mailing Address - Country:US
Mailing Address - Phone:281-852-2150
Mailing Address - Fax:281-852-0356
Practice Address - Street 1:18700 W LAKE HOUSTON PKWY STE A107
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-3350
Practice Address - Country:US
Practice Address - Phone:281-852-2150
Practice Address - Fax:281-852-0356
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-23
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX245421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice