Provider Demographics
NPI:1093997744
Name:PAUL FITZGERALD DMD PC
Entity Type:Organization
Organization Name:PAUL FITZGERALD DMD PC
Other - Org Name:HINGHAM KINGSTON ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:D
Authorized Official - Last Name:FITZGERALD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-740-0024
Mailing Address - Street 1:185 LINCOLN STREET
Mailing Address - Street 2:#215
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043
Mailing Address - Country:US
Mailing Address - Phone:781-740-0024
Mailing Address - Fax:781-740-0025
Practice Address - Street 1:185 LINCOLN STREET
Practice Address - Street 2:#215
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043
Practice Address - Country:US
Practice Address - Phone:781-740-0024
Practice Address - Fax:781-740-0025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty