Provider Demographics
NPI:1902971161
Name:FRITZ, DAVID RALPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:RALPH
Last Name:FRITZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2820 AAA CT
Mailing Address - Street 2:#3
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-6752
Mailing Address - Country:US
Mailing Address - Phone:563-332-3691
Mailing Address - Fax:563-332-3267
Practice Address - Street 1:2820 AAA CT
Practice Address - Street 2:#3
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-6752
Practice Address - Country:US
Practice Address - Phone:563-332-3691
Practice Address - Fax:563-332-3267
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA065611223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1007618Medicaid