Provider Demographics
NPI:1043052293
Name:FRITSCHE, ERIC JOSEPH
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:JOSEPH
Last Name:FRITSCHE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ERIC
Other - Middle Name:JOSEPH
Other - Last Name:JENKINS-FRITSCHE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:811 SNOWBERRY RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-7692
Mailing Address - Country:US
Mailing Address - Phone:314-517-2652
Mailing Address - Fax:
Practice Address - Street 1:3009 HIGHWAY K
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-8696
Practice Address - Country:US
Practice Address - Phone:636-379-7552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024020828122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist