Healthcare Provider Details

I. General information

NPI: 1851378442
Provider Name (Legal Business Name): PAUL F FITZGERALD D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 STATION AVE
SOUTH YARMOUTH MA
02664-1863
US

IV. Provider business mailing address

241 STATION AVE
SOUTH YARMOUTH MA
02664-1863
US

V. Phone/Fax

Practice location:
  • Phone: 508-398-6055
  • Fax: 508-398-7228
Mailing address:
  • Phone: 508-398-6055
  • Fax: 508-398-7228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number12842
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: