Healthcare Provider Details

I. General information

NPI: 1952480626
Provider Name (Legal Business Name): BRIGID ETHEL MCCANN D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRIGID ETHEL FITCH D.D.S.

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FORT DEFIANCE PHS HOSPITAL CORNER OF RT N12 N7
FORT DEFIANCE AZ
86504
US

IV. Provider business mailing address

PO BOX 155
FORT DEFIANCE AZ
86504-0155
US

V. Phone/Fax

Practice location:
  • Phone: 928-729-8885
  • Fax:
Mailing address:
  • Phone: 928-729-5736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number53002
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: