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General NPI Number Information
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NPI Number | 1386813509
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Entity Type | Organization
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Legal Business Name | FITZPATRICK ,MARY,DDS INC
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Dates
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Enumeration Date | 02/21/2008
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Last Update Date | 02/21/2008
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Provider Practice Location Address
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Address Line | 1601 MCHENRY VILLAGE WAY STE 10-A
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City | MODESTO
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State | CA
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Zip | 95350-4307
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Country | US
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Telephone | 209-527-5727
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Fax | 209-527-4626
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Provider Business Mailing Address
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Address Line | 1601 MCHENRY VILLAGE WAY STE 10-A
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City | MODESTO
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State | CA
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Zip | 95350-4307
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Country | US
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Telephone | 209-527-5727
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Fax | 209-527-4626
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARY LOU FITZPATRICK
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Credential |
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Telephone | 209-527-4631
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 39633
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License Number State | CA
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