Organization
ELLICOTT DENTAL & SPECIALTY LLC
Active
Other names
BluePointe Dental (Ellicott)
Organization subpart
No
Provider details
NPI number
Authorized official
BRYAN FITZGERALD DDS (OWNER)
(410) 910-9641
Entity
Organization
Contact information
Practice address
9200 BALTIMORE NATIONAL PIKE STE E, ELLICOTT CITY, MD 21042-2613
(410) 910-9641
Mailing address
46 VREELAND DR STE 6, SKILLMAN, NJ 08558-2638
(609) 252-9000
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
1223E0200X
Endodontics
—
—
1223G0001X
General Practice Dentistry
—
—
1223P0300X
Periodontics
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
Other
Enumeration date
04/11/2017
Last updated
04/11/2017
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