Individual
MARK FITZGERALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1011 N UNIVERSITY AVE, ANN ARBOR, MI 48109-1078
(734) 647-4246
(734) 647-8090
Mailing address
1011 N UNIVERSITY AVE, ANN ARBOR, MI 48109-1078
(734) 647-4246
(734) 647-8090
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2901012486
MI
1223G0001X
General Practice Dentistry
2901012486
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
195816070
BCBS OF MI MED SURGICAL
MI
01
—
D124860
BCBS OF MI DENTAL
MI
Enumeration date
03/14/2007
Last updated
04/26/2024
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