Provider Demographics
NPI:1225330558
Name:FISHER-RANEL, JOAN TABATHA (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:TABATHA
Last Name:FISHER-RANEL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12841 PLANK RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:BAKER
Mailing Address - State:LA
Mailing Address - Zip Code:70714-4908
Mailing Address - Country:US
Mailing Address - Phone:225-775-3552
Mailing Address - Fax:225-775-3569
Practice Address - Street 1:12841 PLANK RD
Practice Address - Street 2:SUITE A
Practice Address - City:BAKER
Practice Address - State:LA
Practice Address - Zip Code:70714-4908
Practice Address - Country:US
Practice Address - Phone:225-775-3552
Practice Address - Fax:225-775-3569
Is Sole Proprietor?:No
Enumeration Date:2010-11-18
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4877122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1848778Medicaid