Provider Demographics
NPI:1417090515
Name:FRITSCH, BARRY ROBERT
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:ROBERT
Last Name:FRITSCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4371 E 82ND ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-1793
Mailing Address - Country:US
Mailing Address - Phone:317-849-4745
Mailing Address - Fax:317-842-8980
Practice Address - Street 1:4371 E 82ND ST
Practice Address - Street 2:SUITE A
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-1793
Practice Address - Country:US
Practice Address - Phone:317-849-4745
Practice Address - Fax:317-842-8980
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120074681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice