Provider Demographics
NPI:1164452017
Name:FISCHER, MARK EDWARD (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:EDWARD
Last Name:FISCHER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 ROUTE 1
Mailing Address - Street 2:SUITE 1
Mailing Address - City:YARMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04096-4711
Mailing Address - Country:US
Mailing Address - Phone:207-846-7977
Mailing Address - Fax:
Practice Address - Street 1:500 ROUTE 1
Practice Address - Street 2:SUITE 1
Practice Address - City:YARMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04096-4711
Practice Address - Country:US
Practice Address - Phone:207-846-7977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME36021223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics