Provider Demographics
NPI:1174674576
Name:FISCHER, EDWARD J IV (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:J
Last Name:FISCHER
Suffix:IV
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3396 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-5544
Mailing Address - Country:US
Mailing Address - Phone:812-478-2888
Mailing Address - Fax:812-478-2886
Practice Address - Street 1:3396 S 4TH ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-5544
Practice Address - Country:US
Practice Address - Phone:812-478-2888
Practice Address - Fax:812-478-2886
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120098601223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics