Provider Demographics
NPI:1164604898
Name:FITZGERALD, PATRICK J (DDS)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:J
Last Name:FITZGERALD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 S DECATUR ST
Mailing Address - Street 2:
Mailing Address - City:WATKINS GLEN
Mailing Address - State:NY
Mailing Address - Zip Code:14891-1614
Mailing Address - Country:US
Mailing Address - Phone:607-535-4666
Mailing Address - Fax:
Practice Address - Street 1:703 S DECATUR ST
Practice Address - Street 2:
Practice Address - City:WATKINS GLEN
Practice Address - State:NY
Practice Address - Zip Code:14891-1614
Practice Address - Country:US
Practice Address - Phone:607-535-4666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0430991122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist