Provider Demographics
NPI:1730561440
Name:FRITZ, KYMBERLY (DDS)
Entity type:Individual
Prefix:DR
First Name:KYMBERLY
Middle Name:
Last Name:FRITZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 N BEQUETTE ST
Mailing Address - Street 2:
Mailing Address - City:DODGEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53533-1109
Mailing Address - Country:US
Mailing Address - Phone:608-935-5262
Mailing Address - Fax:
Practice Address - Street 1:703 N BEQUETTE ST
Practice Address - Street 2:
Practice Address - City:DODGEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53533-1109
Practice Address - Country:US
Practice Address - Phone:608-935-5262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-18
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1001136-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist