Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 31915 | CA |
N | 1223D0001X | Dental Public Health | 31915 | CA |
Y | 1223G0001X | General Practice | 31915 | CA |
Y | 213EG0000X | General Practice | 31915 | CA |
NPI | 1730248212 |
---|---|
Provider Name | Dennis Craig Fitch |
First Address | San Luis Obispo, CA 93401-5218 |
Second Address | San Luis Obispo, CA 93401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2006 |
Last Update Date | 23/10/2012 |