Provider Demographics
NPI:1023215381
Name:FISCUS, PERRY LEE (DMD)
Entity Type:Individual
Prefix:DR
First Name:PERRY
Middle Name:LEE
Last Name:FISCUS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W 5TH ST
Mailing Address - Street 2:PO BOX 789
Mailing Address - City:RAINIER
Mailing Address - State:OR
Mailing Address - Zip Code:97048-2634
Mailing Address - Country:US
Mailing Address - Phone:503-556-3744
Mailing Address - Fax:503-556-3134
Practice Address - Street 1:101 W 5TH ST
Practice Address - Street 2:
Practice Address - City:RAINIER
Practice Address - State:OR
Practice Address - Zip Code:97048-2634
Practice Address - Country:US
Practice Address - Phone:503-556-3744
Practice Address - Fax:503-556-3134
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD5518122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist