Individual provider Active NPI

Kevin Thomas Fitzpatrick, D.D.S., M.S.

  • General Practice Dentistry
  • Del Mar, CA
National Provider Identifier
1992708903
Registry record updated May 11, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
51729 Issued in CA
Practice address
1333 Camino del Mar
Del Mar, CA 92014-2507
Phone
(858) 755-1197
Fax
(858) 755-4233
NPI assigned
May 23, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 11, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 51729 CA Primary
General Practice Dentistry 1223G0001X 2901016069 MI

Addresses

Primary practice location

1333 Camino del Mar
Del Mar, CA 92014-2507

Mailing address

1333 Camino del Mar
Del Mar, CA 92014-2507
Phone (858) 755-1197

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)
Enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
2901016069MIMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Ian Murray, D.M.D., Inc. General Practice Past Accepting new patients
Traverse Dental Associates, PLLC General Practice PastSince Aug 9, 2014 Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1116806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1431302400000",
    "number": "1992708903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1333 CAMINO DEL MAR",
            "city": "DEL MAR",
            "state": "CA",
            "postal_code": "920142507",
            "telephone_number": "858-755-1197",
            "fax_number": "858-755-4233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1333 CAMINO DEL MAR",
            "city": "DEL MAR",
            "state": "CA",
            "postal_code": "920142507",
            "telephone_number": "858-755-1197",
            "fax_number": "858-755-4233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FITZPATRICK",
        "first_name": "KEVIN",
        "middle_name": "THOMAS",
        "name_prefix": "Dr.",
        "credential": "D.D.S., M.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-05-23",
        "last_updated": "2015-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "51729",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901016069",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Del Mar, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 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.

Verify at the official NPI Registry.