Provider Demographics
NPI:1124216304
Name:FISHER, STEPHEN D (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:D
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 1:1 RIVERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:POTSDAM
Mailing Address - State:NY
Mailing Address - Zip Code:13676-2090
Mailing Address - Country:US
Mailing Address - Phone:315-265-2896
Mailing Address - Fax:315-265-1035
Practice Address - Street 1:1 RIVERVIEW DR
Practice Address - Street 2:
Practice Address - City:POTSDAM
Practice Address - State:NY
Practice Address - Zip Code:13676-2090
Practice Address - Country:US
Practice Address - Phone:315-265-2896
Practice Address - Fax:315-265-1035
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-12
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0325261223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery