Provider Demographics
NPI:1851378442
Name:FITZGERALD, PAUL F (DMD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:F
Last Name:FITZGERALD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:241 STATION AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH YARMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02664-1863
Mailing Address - Country:US
Mailing Address - Phone:508-398-6055
Mailing Address - Fax:508-398-7228
Practice Address - Street 1:241 STATION AVE
Practice Address - Street 2:
Practice Address - City:SOUTH YARMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02664-1863
Practice Address - Country:US
Practice Address - Phone:508-398-6055
Practice Address - Fax:508-398-7228
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA128421223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAT57154Medicare UPIN