Provider Demographics
NPI:1164520177
Name:FISCHBACH, ROSEMARIE (DMD)
Entity Type:Individual
Prefix:
First Name:ROSEMARIE
Middle Name:
Last Name:FISCHBACH
Suffix:
Gender:F
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:PO BOX 2017
Mailing Address - Street 2:
Mailing Address - City:CEIBA
Mailing Address - State:PR
Mailing Address - Zip Code:00735
Mailing Address - Country:US
Mailing Address - Phone:787-863-8440
Mailing Address - Fax:787-885-8497
Practice Address - Street 1:CARR #3 KM 21 SUITE 2
Practice Address - Street 2:MARGINAL LA DOLORES
Practice Address - City:RIO GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00745
Practice Address - Country:US
Practice Address - Phone:787-863-8440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1722122300000X
TX309731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR41589 FIOtherTRIPLE-S PROVIDER NUMBER