Provider Demographics
NPI:1801049010
Name:FITZGERALD PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:FITZGERALD PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:H
Authorized Official - Last Name:FITZGERALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-922-9220
Mailing Address - Street 1:7054 EAST COCHISE RD
Mailing Address - Street 2:B-230
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-4550
Mailing Address - Country:US
Mailing Address - Phone:480-922-9220
Mailing Address - Fax:480-922-0575
Practice Address - Street 1:7054 EAST COCHISE RD
Practice Address - Street 2:B-230
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85253-4550
Practice Address - Country:US
Practice Address - Phone:480-922-9220
Practice Address - Fax:480-922-0575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-31
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty