Provider Demographics
NPI:1316199078
Name:FISCHER, DAVID VERGIL (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:VERGIL
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 1:13664 ROCKWAY PL
Mailing Address - Street 2:
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95959-9272
Mailing Address - Country:US
Mailing Address - Phone:165-864-9109
Mailing Address - Fax:165-864-9109
Practice Address - Street 1:463 SUTTON WAY
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-4102
Practice Address - Country:US
Practice Address - Phone:530-273-1470
Practice Address - Fax:165-864-9109
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-14
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1028701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice