Provider Demographics
NPI:1508955311
Name:FITZGERALD, JAY PATRICK (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:PATRICK
Last Name:FITZGERALD
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 36TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-4703
Mailing Address - Country:US
Mailing Address - Phone:405-360-7716
Mailing Address - Fax:405-360-0047
Practice Address - Street 1:444 36TH AVE NW
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-4703
Practice Address - Country:US
Practice Address - Phone:405-360-7716
Practice Address - Fax:405-360-0047
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK48711223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics