Provider Demographics
NPI:1265058127
Name:FITZGIBBON, DREW (DMD)
Entity type:Individual
Prefix:
First Name:DREW
Middle Name:
Last Name:FITZGIBBON
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 1:167 HUSTON RD
Mailing Address - Street 2:
Mailing Address - City:GORHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04038-5804
Mailing Address - Country:US
Mailing Address - Phone:603-479-6680
Mailing Address - Fax:
Practice Address - Street 1:1364 MAIN ST
Practice Address - Street 2:SUITE 20
Practice Address - City:SANFORD
Practice Address - State:ME
Practice Address - Zip Code:04073-3777
Practice Address - Country:US
Practice Address - Phone:207-324-4003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-17
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME48011223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice