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General NPI Number Information
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NPI Number | 1417207606
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Entity Type | Organization
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Legal Business Name | JOHN F. FRITZ, JR., D.M.D., R.PH, P.S.C.
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Dates
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Enumeration Date | 09/14/2012
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Last Update Date | 09/14/2012
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Provider Practice Location Address
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Address Line | 9014 LYNDON LAKES PL
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City | LOUISVILLE
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State | KY
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Zip | 40242-4541
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Country | US
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Telephone | 502-376-4557
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Fax |
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Provider Business Mailing Address
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Address Line | 9014 LYNDON LAKES PL
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City | LOUISVILLE
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State | KY
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Zip | 40242-4541
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Country | US
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Telephone | 502-376-4557
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/C.E.O.
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Name | DR. JOHN F. FRITZ JR.
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Credential | D.M.D., R.PH.
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Telephone | 502-376-4557
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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 | 6785
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 009474
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 6785
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License Number State | KY
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