Provider Demographics
NPI:1023546777
Name:FISHER, ALEXANDER SCOTT (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:SCOTT
Last Name:FISHER
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 1:30 N MICHIGAN AVE STE 1506
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-3689
Mailing Address - Country:US
Mailing Address - Phone:312-372-4845
Mailing Address - Fax:
Practice Address - Street 1:30 N MICHIGAN AVE STE 1506
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-3689
Practice Address - Country:US
Practice Address - Phone:312-372-4845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-25
Last Update Date:2021-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0328041223G0001X
NJ22DI026793001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice