Healthcare Provider Details

I. General information

NPI: 1053245290
Provider Name (Legal Business Name): CONNOR FITZGERALD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 BRYAN DAIRY RD STE 350
LARGO FL
33777-1358
US

IV. Provider business mailing address

8200 BRYAN DAIRY RD STE 350
LARGO FL
33777-1358
US

V. Phone/Fax

Practice location:
  • Phone: 727-397-1519
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN31857
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: