Provider Demographics
NPI:1558731380
Name:FITZGERALD, LINDSEY (DDS)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3525 PAOLI PIKE
Mailing Address - Street 2:
Mailing Address - City:FLOYDS KNOBS
Mailing Address - State:IN
Mailing Address - Zip Code:47119-9751
Mailing Address - Country:US
Mailing Address - Phone:812-948-5930
Mailing Address - Fax:
Practice Address - Street 1:3525 PAOLI PIKE
Practice Address - Street 2:
Practice Address - City:FLOYDS KNOBS
Practice Address - State:IN
Practice Address - Zip Code:47119-9751
Practice Address - Country:US
Practice Address - Phone:812-948-5930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-06
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012329A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist