Healthcare Provider Details

I. General information

NPI: 1386322097
Provider Name (Legal Business Name): EDEN MARIE FITZGIBBONS DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2023
Last Update Date: 02/22/2026
Certification Date: 02/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 SW 29TH ST STE M
TOPEKA KS
66611-1163
US

IV. Provider business mailing address

400 SW 29TH ST STE M
TOPEKA KS
66611-1163
US

V. Phone/Fax

Practice location:
  • Phone: 785-783-5981
  • Fax:
Mailing address:
  • Phone: 785-783-5981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number62063
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2023023745
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: