Provider Demographics
NPI:1467661850
Name:FITZPATRICK, J. WARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:J.
Middle Name:WARD
Last Name:FITZPATRICK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 3RD AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-5806
Mailing Address - Country:US
Mailing Address - Phone:570-283-3300
Mailing Address - Fax:570-331-7129
Practice Address - Street 1:550 3RD AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-5806
Practice Address - Country:US
Practice Address - Phone:570-283-3300
Practice Address - Fax:570-331-7129
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026620L1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics