Provider Demographics
NPI:1265505663
Name:FITZGERALD, LORI A (DDS)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:A
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 1:5711 SHIELDS RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406
Mailing Address - Country:US
Mailing Address - Phone:330-533-0804
Mailing Address - Fax:
Practice Address - Street 1:5711 SHIELDS RD
Practice Address - Street 2:SUITE A
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406
Practice Address - Country:US
Practice Address - Phone:330-533-0804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1859681122300000X
OH20977122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist