Provider Demographics
NPI:1063649317
Name:SEAN E. FITZGERALD, D.D.S., P.A.
Entity Type:Organization
Organization Name:SEAN E. FITZGERALD, D.D.S., P.A.
Other - Org Name:FITZGERALD FAMILY DENTAL PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:FITZGERALD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-852-2150
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:
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-14
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX245421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty