Healthcare Provider Details

I. General information

NPI: 1760007850
Provider Name (Legal Business Name): LAYTON FRITSCH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2020
Last Update Date: 06/15/2020
Certification Date: 06/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4090 21ST AVE SW
CEDAR RAPIDS IA
52404-6308
US

IV. Provider business mailing address

4090 21ST AVE SW
CEDAR RAPIDS IA
52404-6308
US

V. Phone/Fax

Practice location:
  • Phone: 563-451-6242
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDDS-09757
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDDS-09757
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: