MEDICARE: DR. KEVIN THOMAS FITZPATRICK D.D.S., M.S.

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	51729	CA
2	1223G0001X	General Practice Dentistry	2901016069	MI

General Provider Information

NPI Number	:	1992708903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN THOMAS FITZPATRICK D.D.S., M.S.

Provider Business Mailing Address
First Line	:	1333 CAMINO DEL MAR
Second Line	:
City	:	DEL MAR
State	:	CA
Zip	:	92014-2507
Country	:	US
Telephone Number	:	858-755-1197
Fax Number	:	858-755-4233

Provider Business Practice Location Address
First Line	:	1333 CAMINO DEL MAR
Second Line	:
City	:	DEL MAR
State	:	CA
Zip	:	92014-2507
Country	:	US
Telephone Number	:	858-755-1197
Fax Number	:	858-755-4233

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	05/11/2015

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