Provider Demographics
NPI:1407960230
Name:DRS. FRITZ & MCCAULEY
Entity Type:Organization
Organization Name:DRS. FRITZ & MCCAULEY
Other - Org Name:DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:G
Authorized Official - Last Name:MCCAULEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:218-847-2624
Mailing Address - Street 1:1136 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:56501-3411
Mailing Address - Country:US
Mailing Address - Phone:218-847-2624
Mailing Address - Fax:218-847-5792
Practice Address - Street 1:1136 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:DETROIT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56501-3411
Practice Address - Country:US
Practice Address - Phone:218-847-2624
Practice Address - Fax:218-847-5792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN3100013Medicare ID - Type Unspecified