Provider Demographics
NPI:1225648488
Name:FITZGERALD, LAUREN ELIZABETH (DMD)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:ELIZABETH
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-1605
Mailing Address - Country:US
Mailing Address - Phone:781-438-1995
Mailing Address - Fax:
Practice Address - Street 1:112 MAIN ST
Practice Address - Street 2:
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-1605
Practice Address - Country:US
Practice Address - Phone:781-438-1995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-03
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1858740122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist