NPIMap

Organization Active NPI

Frederick M. Fitzpatrick, D.D.S., P.C.

  • Pediatric Dentistry
  • Crystal Lake, IL
National Provider Identifier
1700990447
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
A13595 Issued in IL
Legal business name
FREDERICK M. FITZPATRICK, D.D.S., P.C.
Practice address
690 N Il Route 31
Crystal Lake, IL 60012-3790
Phone
(815) 459-2727
NPI assigned
Aug 19, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Fred M FitzpatrickNPI 1063526796
Title
President
Phone
(815) 459-2727

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X A13595 IL Primary

Addresses

Primary practice location

690 N Il Route 31
Crystal Lake, IL 60012-3790

Mailing address

651 Woodland Dr
Crystal Lake, IL 60014-5214
Phone (815) 459-9230

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155945600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1700990447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "651 WOODLAND DR",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600145214",
            "telephone_number": "815-459-9230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "690 N IL ROUTE 31",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600123790",
            "telephone_number": "815-459-2727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FREDERICK M. FITZPATRICK, D.D.S., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FITZPATRICK",
        "authorized_official_first_name": "FRED",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "815-459-2727",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "IL",
            "license": "A13595",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Crystal Lake, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.