Provider Demographics
NPI:1124880125
Name:WEST BROAD DENTAL - JEFFREY R. FISHER DDS, INC.
Entity type:Organization
Organization Name:WEST BROAD DENTAL - JEFFREY R. FISHER DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:614-870-8474
Mailing Address - Street 1:5688 W BROAD ST STE B
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:OH
Mailing Address - Zip Code:43119-8127
Mailing Address - Country:US
Mailing Address - Phone:614-870-8474
Mailing Address - Fax:
Practice Address - Street 1:5688 W BROAD ST STE B
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:OH
Practice Address - Zip Code:43119-8127
Practice Address - Country:US
Practice Address - Phone:614-870-8474
Practice Address - Fax:614-870-8475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty