Provider Demographics
NPI:1073878294
Name:JOSEPH T FITZPATRICK DDS PC
Entity Type:Organization
Organization Name:JOSEPH T FITZPATRICK DDS PC
Other - Org Name:GENTLE DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:FITZPATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-391-1047
Mailing Address - Street 1:10730 PACIFIC ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-4799
Mailing Address - Country:US
Mailing Address - Phone:402-391-1047
Mailing Address - Fax:
Practice Address - Street 1:10730 PACIFIC ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-4799
Practice Address - Country:US
Practice Address - Phone:402-391-1047
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-13
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE70211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty