MEDICARE: DR. RUSSELL PATRICK FITTON III 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	19-17609	IL

General Provider Information

NPI Number	:	1083651582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUSSELL PATRICK FITTON III DDS

Provider Business Mailing Address
First Line	:	820 S NORTHWEST HWY
Second Line	:
City	:	BARRINGTON
State	:	IL
Zip	:	60010-4622
Country	:	US
Telephone Number	:	847-381-3927
Fax Number	:	847-381-4575

Provider Business Practice Location Address
First Line	:	820 S NORTHWEST HWY
Second Line	:
City	:	BARRINGTON
State	:	IL
Zip	:	60010-4622
Country	:	US
Telephone Number	:	847-381-3927
Fax Number	:	847-381-4575

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

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	07/08/2007

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