Provider Demographics
NPI:1417207606
Name:JOHN F. FRITZ, JR., D.M.D., R.PH, P.S.C.
Entity Type:Organization
Organization Name:JOHN F. FRITZ, JR., D.M.D., R.PH, P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/C.E.O.
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:F
Authorized Official - Last Name:FRITZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD, RPH
Authorized Official - Phone:502-376-4557
Mailing Address - Street 1:9014 LYNDON LAKES PL
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40242-4541
Mailing Address - Country:US
Mailing Address - Phone:502-376-4557
Mailing Address - Fax:
Practice Address - Street 1:9014 LYNDON LAKES PL
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40242-4541
Practice Address - Country:US
Practice Address - Phone:502-376-4557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6785122300000X, 1223G0001X
KY009474183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty