Provider Demographics
NPI:1699778241
Name:FISH, ROBERT J (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:FISH
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 1:7737 N UNIVERSITY DR
Mailing Address - Street 2:STE 100
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-2968
Mailing Address - Country:US
Mailing Address - Phone:954-720-7700
Mailing Address - Fax:954-724-4448
Practice Address - Street 1:7737 N UNIVERSITY DR
Practice Address - Street 2:STE 100
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2968
Practice Address - Country:US
Practice Address - Phone:954-720-7700
Practice Address - Fax:954-724-4448
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2016-06-01
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2016-06-01
Provider Licenses
StateLicense IDTaxonomies
FLDN0005694122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist