Provider Demographics
NPI:1043625684
Name:FISHER, TODD (DDS)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:
Last Name:FISHER
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 1:3411 MEMORIAL BLVD
Mailing Address - Street 2:SUITE A2
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-3697
Mailing Address - Country:US
Mailing Address - Phone:615-948-0694
Mailing Address - Fax:
Practice Address - Street 1:3411 MEMORIAL BLVD
Practice Address - Street 2:SUITE A2
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-3697
Practice Address - Country:US
Practice Address - Phone:615-948-0694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-23
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9877122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist