Provider Demographics
NPI:1023106135
Name:HARSHBERGER, FRITZ ROLAND (DMD)
Entity type:Individual
Prefix:DR
First Name:FRITZ
Middle Name:ROLAND
Last Name:HARSHBERGER
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 1:24208 US HIGHWAY 98 STE C
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-3467
Mailing Address - Country:US
Mailing Address - Phone:251-210-1777
Mailing Address - Fax:251-210-1778
Practice Address - Street 1:24208 US HIGHWAY 98 STE C
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-3467
Practice Address - Country:US
Practice Address - Phone:251-210-1777
Practice Address - Fax:251-210-1778
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL241811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL201296079OtherTAX ID