Healthcare Provider Details

I. General information

NPI: 1205074879
Provider Name (Legal Business Name): EDWARD KENT FRITCH D.D.S., M.S.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2009
Last Update Date: 04/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18650 N THOMPSON PEAK PKWY SUITE 2010
SCOTTSDALE AZ
85255-6190
US

IV. Provider business mailing address

18650 N THOMPSON PEAK PKWY SUITE 2010
SCOTTSDALE AZ
85255-6190
US

V. Phone/Fax

Practice location:
  • Phone: 602-689-0508
  • Fax:
Mailing address:
  • Phone: 602-689-0508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberAZ4516
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: