Provider Demographics
NPI:1194246942
Name:FISCHER, BENJAMIN ISAAC (DDS)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:ISAAC
Last Name:FISCHER
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 1:415 N 26TH ST STE 302
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47904-2893
Mailing Address - Country:US
Mailing Address - Phone:765-448-6831
Mailing Address - Fax:
Practice Address - Street 1:415 N 26TH ST STE 302
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-2893
Practice Address - Country:US
Practice Address - Phone:765-448-6831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-02
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012740A122300000X, 1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist