MEDICARE: DR. SEAN EDWARD FITZGERALD DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	24542	TX

General Provider Information

NPI Number	:	1003218991
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SEAN EDWARD FITZGERALD DDS

Provider Business Mailing Address
First Line	:	18700 W LAKE HOUSTON PKWY STE A107
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77346-3350
Country	:	US
Telephone Number	:	281-852-2150
Fax Number	:	281-852-0356

Provider Business Practice Location Address
First Line	:	18700 W LAKE HOUSTON PKWY STE A107
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77346-3350
Country	:	US
Telephone Number	:	281-852-2150
Fax Number	:	281-852-0356

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2014
Last Update Date	:	01/08/2020

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