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: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2019 HUGHES DR. JOBST TOWER, 6TH FLOOR
TOLEDO OH
43606
US

IV. Provider business mailing address

2019 HUGHES DR. JOBST TOWER, 6TH FLOOR
TOLEDO OH
43606
US

V. Phone/Fax

Practice location:
  • Phone: 419-291-7222
  • Fax:
Mailing address:
  • Phone: 419-291-7222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberRES.005022
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: