Provider Demographics
NPI:1730248212
Name:FITCH, DENNIS CRAIG (DDS)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:CRAIG
Last Name:FITCH
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 1:2240 EMILY ST
Mailing Address - Street 2:STE 150
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-5218
Mailing Address - Country:US
Mailing Address - Phone:805-541-3900
Mailing Address - Fax:805-541-3900
Practice Address - Street 1:2240 EMILY, SUITE 150
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401
Practice Address - Country:US
Practice Address - Phone:760-943-1449
Practice Address - Fax:760-943-7674
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31915122300000X, 1223G0001X, 1223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
No1223D0001XDental ProvidersDentistDental Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6394210001Medicare NSC