Provider Demographics
NPI:1093768905
Name:HENRY J. FIORITTO, D.D.S., INC.
Entity Type:Organization
Organization Name:HENRY J. FIORITTO, D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:FIORITTO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:440-951-5511
Mailing Address - Street 1:6303 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-2467
Mailing Address - Country:US
Mailing Address - Phone:440-951-5511
Mailing Address - Fax:440-255-5320
Practice Address - Street 1:6303 CENTER ST
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-2467
Practice Address - Country:US
Practice Address - Phone:440-951-5511
Practice Address - Fax:440-255-5320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH136661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========00Medicare ID - Type Unspecified