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General NPI Number Information
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NPI Number | 1063649317
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Entity Type | Organization
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Legal Business Name | SEAN E. FITZGERALD, D.D.S., P.A.
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Dates
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Enumeration Date | 06/14/2009
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Last Update Date | 01/08/2020
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Provider Practice Location Address
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Address Line | 18700 W LAKE HOUSTON PKWY STE A107
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City | HUMBLE
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State | TX
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Zip | 77346-3350
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Country | US
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Telephone | 281-852-2150
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Fax | 281-852-0356
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Provider Business Mailing Address
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Address Line | 18700 W LAKE HOUSTON PKWY STE A107
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City | HUMBLE
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State | TX
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Zip | 77346-3350
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Country | US
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Telephone | 281-852-2150
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SEAN E. FITZGERALD
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Credential | D.D.S.
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Telephone | 281-852-2150
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 24542
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License Number State | TX
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