Mary Lou Fitzpatrick, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

39633 Issued in CA

Practice address

1601 McHenry Village Way
Suite 10-a
Modesto, CA 95350-4307

Phone

(209) 527-5727

Fax

(209) 527-4626

NPI assigned

Dec 1, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Fitzpatrick ,Mary,DDS Inc

  • Dentist
  • Modesto, CA
  • NPI 1386813509
  NPD (past) Authorized official

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

{
    "created_epoch": "1164931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1811065527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 MC HENRY VILLAGE WAY",
            "address_2": "SUITE 10-A",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "95350",
            "telephone_number": "209-527-5727",
            "fax_number": "209-527-4626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 MCHENRY VILLAGE WAY",
            "address_2": "SUITE 10-A",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953504307",
            "telephone_number": "209-527-5727",
            "fax_number": "209-527-4626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FITZPATRICK",
        "first_name": "MARY",
        "middle_name": "LOU",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "39633",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ian Timothy Fitzgerald, PA-C
• John Fitzgerald
• Michelle Don Fitzgerald
• Fitzpatrick ,Mary,DDS Inc
• Dale Walter Fitzpatrick, MD
• Michael Edward Fitzpatrick, M.D.
• Five Leaf Colver Trucking LLC
• Kristen E. Flack, AGNP
• Francis R Flaim, MD
• Rebecca Flanagan, D.O.

• General Practice Dentistry in Modesto, CA
• Providers in Modesto, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.