Provider Demographics
NPI:1932235645
Name:RICHARD D. FITZGERALD, DDS, PC
Entity Type:Organization
Organization Name:RICHARD D. FITZGERALD, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:D
Authorized Official - Last Name:FITZGERALD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-551-1757
Mailing Address - Street 1:5709 NW RADIAL HWY
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68104-4141
Mailing Address - Country:US
Mailing Address - Phone:402-551-1757
Mailing Address - Fax:402-551-1517
Practice Address - Street 1:5709 NW RADIAL HWY
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68104-4141
Practice Address - Country:US
Practice Address - Phone:402-551-1757
Practice Address - Fax:402-551-1517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE40081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
872534OtherUNITED CONCORDIA INSURANC
0005998396OtherAETNA
NE4902OtherBLUE CROSS BLUE SHIELD
DN710OtherFEDS HEAL
872534OtherUNITED CONCORDIA INSURANC