Provider Demographics
NPI:1174631097
Name:FISHER, STEPHEN CARL (DDS)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:CARL
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 1:1101 POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72830
Mailing Address - Country:US
Mailing Address - Phone:479-754-3357
Mailing Address - Fax:479-754-0167
Practice Address - Street 1:1101 POPLAR ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:AR
Practice Address - Zip Code:72830
Practice Address - Country:US
Practice Address - Phone:479-754-3357
Practice Address - Fax:479-754-0167
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR2468122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR58513OtherBCBS
AR115817OtherUCCI
AR58513OtherBCBS