Provider Demographics
NPI:1871581777
Name:FITCHETT, GLANDER JR (DENTIST)
Entity type:Individual
Prefix:MR
First Name:GLANDER
Middle Name:
Last Name:FITCHETT
Suffix:JR
Gender:M
Credentials:DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 POST OFFICE RD
Mailing Address - Street 2:208
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-1914
Mailing Address - Country:US
Mailing Address - Phone:301-870-7077
Mailing Address - Fax:301-843-8030
Practice Address - Street 1:603 POST OFFICE RD
Practice Address - Street 2:208
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-1914
Practice Address - Country:US
Practice Address - Phone:301-870-7077
Practice Address - Fax:301-843-8030
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD096981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice