Active NPI
Adam Fritzgerald, DMD
- General Practice Dentistry
- Collinsville, IL
National Provider Identifier
1891176897
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 019.030179
- Practice address
- 473 Parkside Commons CT
Collinsville, IL 62234-4488 - Phone
- (217) 412-9940
- NPI assigned
- Jun 15, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 019.030179 | IL | Primary |
Addresses
Primary practice location
473 Parkside Commons CT
Collinsville, IL 62234-4488
Mailing address
473 Parkside Commons CT
Collinsville, IL 62234-4488
Phone (217) 412-9940
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019.030179 | IL | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1434326400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1434326400000",
"number": "1891176897",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "473 PARKSIDE COMMONS CT",
"city": "COLLINSVILLE",
"state": "IL",
"postal_code": "622344488",
"telephone_number": "217-412-9940"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "473 PARKSIDE COMMONS CT",
"city": "COLLINSVILLE",
"state": "IL",
"postal_code": "622344488",
"telephone_number": "217-412-9940"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FRITZGERALD",
"first_name": "ADAM",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-06-15",
"last_updated": "2015-06-15",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "IL",
"license": "019.030179",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Collinsville, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.