Provider Demographics
NPI:1124023684
Name:FITZGERALD, JANET (DDS)
Entity Type:Individual
Prefix:DR
First Name:JANET
Middle Name:
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5132 SHERIDAN DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-4623
Mailing Address - Country:US
Mailing Address - Phone:716-632-2545
Mailing Address - Fax:716-635-0085
Practice Address - Street 1:5132 SHERIDAN DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-4623
Practice Address - Country:US
Practice Address - Phone:716-632-2545
Practice Address - Fax:716-635-0085
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-20
Last Update Date:2007-07-08
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-30
Provider Licenses
StateLicense IDTaxonomies
NY0435271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000732466002OtherBLUE CROSS BLUE SHIELD
NY4001063OtherINDEPENDANT HEALTH