Provider Demographics
NPI:1083216436
Name:BRIAN R. FISHER
Entity Type:Organization
Organization Name:BRIAN R. FISHER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:T
Authorized Official - Last Name:QUINTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-941-1898
Mailing Address - Street 1:843 S GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-3468
Mailing Address - Country:US
Mailing Address - Phone:231-941-1898
Mailing Address - Fax:
Practice Address - Street 1:843 S GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-3468
Practice Address - Country:US
Practice Address - Phone:231-941-1898
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-11
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty