Provider Demographics
NPI:1306920301
Name:FISHER FAMILY DENTISTRY PC
Entity type:Organization
Organization Name:FISHER FAMILY DENTISTRY PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:E
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-697-7102
Mailing Address - Street 1:253 BEDFORD STREET
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02324
Mailing Address - Country:US
Mailing Address - Phone:508-697-7102
Mailing Address - Fax:508-697-5102
Practice Address - Street 1:253 BEDFORD ST
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02324-3111
Practice Address - Country:US
Practice Address - Phone:508-697-7102
Practice Address - Fax:508-697-5102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty