Provider Demographics
NPI:1124366737
Name:FISHER, DAVID BROGDON (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BROGDON
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 1:1310 MATSON MANOR CT
Mailing Address - Street 2:
Mailing Address - City:KLEIN
Mailing Address - State:TX
Mailing Address - Zip Code:77379-5608
Mailing Address - Country:US
Mailing Address - Phone:713-725-5247
Mailing Address - Fax:
Practice Address - Street 1:1310 MATSON MANOR CT
Practice Address - Street 2:
Practice Address - City:KLEIN
Practice Address - State:TX
Practice Address - Zip Code:77379-5608
Practice Address - Country:US
Practice Address - Phone:713-725-5247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28618122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist