Provider Demographics
NPI:1073631263
Name:FISHER, ERIC BERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:BERT
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 1:545 OLD COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-4923
Mailing Address - Country:US
Mailing Address - Phone:516-942-4440
Mailing Address - Fax:516-942-2647
Practice Address - Street 1:545 OLD COUNTRY RD
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-4923
Practice Address - Country:US
Practice Address - Phone:516-942-4440
Practice Address - Fax:516-942-2647
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0385381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice