Provider Demographics
NPI:1306434873
Name:JOHN O. FISHELL JR., DMD, MDS, INC.
Entity type:Organization
Organization Name:JOHN O. FISHELL JR., DMD, MDS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:OLIVER
Authorized Official - Last Name:FISHELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD, MDS
Authorized Official - Phone:724-207-0870
Mailing Address - Street 1:375 VALLEY BROOK ROAD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:MCMURRAY
Mailing Address - State:PA
Mailing Address - Zip Code:15317
Mailing Address - Country:US
Mailing Address - Phone:724-941-9600
Mailing Address - Fax:724-565-1643
Practice Address - Street 1:375 VALLEY BROOK ROAD
Practice Address - Street 2:SUITE 109
Practice Address - City:MCMURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317
Practice Address - Country:US
Practice Address - Phone:724-941-9600
Practice Address - Fax:724-565-1643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-09
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty