Provider Demographics
NPI:1720208572
Name:FITZGERALD, PAUL DANIELSON (DMD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:DANIELSON
Last Name:FITZGERALD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 LINCOLN STREET
Mailing Address - Street 2:#215
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043
Mailing Address - Country:US
Mailing Address - Phone:781-740-0024
Mailing Address - Fax:781-740-0025
Practice Address - Street 1:185 LINCOLN STREET
Practice Address - Street 2:#215
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043
Practice Address - Country:US
Practice Address - Phone:781-740-0024
Practice Address - Fax:781-740-0025
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA191741223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics