MEDICARE: DR. MICHAEL FRANCIS FITZPATRICK D.M.D.

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	122300000X	Dentist	16855	MA

General Provider Information

NPI Number	:	1134314883
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL FRANCIS FITZPATRICK D.M.D.

Provider Business Mailing Address
First Line	:	22 MILL ST
Second Line	:	SUITE 002
City	:	ARLINGTON
State	:	MA
Zip	:	02476-4738
Country	:	US
Telephone Number	:	781-646-4822
Fax Number	:	781-646-4873

Provider Business Practice Location Address
First Line	:	22 MILL ST
Second Line	:	SUITE 002
City	:	ARLINGTON
State	:	MA
Zip	:	02476-4738
Country	:	US
Telephone Number	:	781-646-4822
Fax Number	:	781-646-4873

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

Provider Enumeration Date	:	09/06/2007
Last Update Date	:	09/06/2007

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