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General NPI Number Information
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NPI Number | 1720331036
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Entity Type | Organization
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Legal Business Name | J. WARD FITZPATRICK DDS
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Dates
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Enumeration Date | 10/24/2012
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Last Update Date | 10/24/2012
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Provider Practice Location Address
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Address Line | 123 PIKE ST
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City | PORT JERVIS
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State | NY
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Zip | 12771-1824
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Country | US
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Telephone | 845-856-3311
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Fax | 845-856-5389
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Provider Business Mailing Address
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Address Line | 123 PIKE ST
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City | PORT JERVIS
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State | NY
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Zip | 12771-1824
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Country | US
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Telephone | 845-856-3311
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Fax | 845-856-5389
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Authorized Official
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Title or Position | OWNER
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Name | DR. WARD FITZPATRICK
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Credential | D.D.S.
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Telephone | 570-283-3300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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