Provider Demographics
NPI:1992010482
Name:KRISTEN H. FRITZ, D.D.S., M.S. & TODD S. BOVENIZER, D.D.S., M.S., P.A.
Entity Type:Organization
Organization Name:KRISTEN H. FRITZ, D.D.S., M.S. & TODD S. BOVENIZER, D.D.S., M.S., P.A.
Other - Org Name:FRITZ AND BOVENIZER ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:HURLEY
Authorized Official - Last Name:FRITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:919-285-4481
Mailing Address - Street 1:224 VILLAGE WALK DR
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-7681
Mailing Address - Country:US
Mailing Address - Phone:919-285-9981
Mailing Address - Fax:919-285-9989
Practice Address - Street 1:224 VILLAGE WALK DR
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540-7681
Practice Address - Country:US
Practice Address - Phone:919-285-9981
Practice Address - Fax:919-285-9989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-09
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC84341223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty