Provider Demographics
NPI:1831249671
Name:MAITLAND, FITZROY ST LAWRENCE (DDS)
Entity type:Individual
Prefix:MR
First Name:FITZROY
Middle Name:ST LAWRENCE
Last Name:MAITLAND
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353 OCEAN AVE
Mailing Address - Street 2:APT 1H
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226
Mailing Address - Country:US
Mailing Address - Phone:718-282-5128
Mailing Address - Fax:718-703-3469
Practice Address - Street 1:353 OCEAN AVE
Practice Address - Street 2:APT 1H
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226
Practice Address - Country:US
Practice Address - Phone:718-282-5128
Practice Address - Fax:718-703-3469
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY396361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice