Provider Demographics
NPI:1417018185
Name:DINITZ, FRED P (DDS INC)
Entity Type:Individual
Prefix:MR
First Name:FRED
Middle Name:P
Last Name:DINITZ
Suffix:
Gender:M
Credentials:DDS INC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8101 LAGUNA BLVD
Mailing Address - Street 2:STE 1
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-7946
Mailing Address - Country:US
Mailing Address - Phone:916-683-4333
Mailing Address - Fax:916-691-4339
Practice Address - Street 1:8101 LAGUNA BLVD
Practice Address - Street 2:STE 1
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-7946
Practice Address - Country:US
Practice Address - Phone:916-683-4333
Practice Address - Fax:916-691-4339
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00230951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice