Provider Demographics
NPI:1922760412
Name:BRENDA G FRITZ DMD PC
Entity Type:Organization
Organization Name:BRENDA G FRITZ DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:G
Authorized Official - Last Name:FRITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:706-692-6429
Mailing Address - Street 1:585 COVE RD
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:GA
Mailing Address - Zip Code:30143-1358
Mailing Address - Country:US
Mailing Address - Phone:706-692-6429
Mailing Address - Fax:
Practice Address - Street 1:585 COVE RD
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-1358
Practice Address - Country:US
Practice Address - Phone:706-692-6429
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty