Provider Demographics
NPI:1710961818
Name:FRITSCH, THOMAS M (DDS PC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:M
Last Name:FRITSCH
Suffix:
Gender:M
Credentials:DDS PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 N 56TH STREET
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68504-3115
Mailing Address - Country:US
Mailing Address - Phone:402-467-3636
Mailing Address - Fax:402-467-3639
Practice Address - Street 1:1600 N 56TH STREET
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68504-3115
Practice Address - Country:US
Practice Address - Phone:402-467-3636
Practice Address - Fax:402-467-3639
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-01
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE56671223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice