Provider Demographics
NPI:1356454474
Name:FITZER, MARTHA (DMD)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:FITZER
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 1:255 GREAT RD
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-4739
Mailing Address - Country:US
Mailing Address - Phone:978-266-1614
Mailing Address - Fax:978-263-3191
Practice Address - Street 1:255 GREAT RD
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-4739
Practice Address - Country:US
Practice Address - Phone:978-266-1614
Practice Address - Fax:978-263-3191
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15943122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist