Provider Demographics
NPI:1689015018
Name:FITZSIMMONS, STEPHEN KEITH
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:KEITH
Last Name:FITZSIMMONS
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 1:500 ROUTE 23
Mailing Address - Street 2:SUITE 6
Mailing Address - City:POMPTON PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07444-1850
Mailing Address - Country:US
Mailing Address - Phone:973-831-9100
Mailing Address - Fax:973-831-6047
Practice Address - Street 1:500 ROUTE 23
Practice Address - Street 2:SUITE 6
Practice Address - City:POMPTON PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07444-1853
Practice Address - Country:US
Practice Address - Phone:973-831-9100
Practice Address - Fax:973-831-6047
Is Sole Proprietor?:No
Enumeration Date:2013-07-15
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ9848122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist