Provider Demographics
NPI:1225173974
Name:FRITZ, EDWARD R (DDS)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:R
Last Name:FRITZ
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 1:2830 E BROWN RD
Mailing Address - Street 2:STE 9
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85213-5430
Mailing Address - Country:US
Mailing Address - Phone:480-830-3305
Mailing Address - Fax:480-830-9584
Practice Address - Street 1:2830 E BROWN RD
Practice Address - Street 2:STE 9
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85213-5430
Practice Address - Country:US
Practice Address - Phone:480-830-3305
Practice Address - Fax:480-830-9584
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice