Provider Demographics
NPI:1235582644
Name:FISHER, ADRIAN ELIZABETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:ADRIAN
Middle Name:ELIZABETH
Last Name:FISHER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:ADRIAN
Other - Middle Name:ELIZABETH
Other - Last Name:FORMANEK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:4930 SE 14TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50320-1604
Mailing Address - Country:US
Mailing Address - Phone:515-650-9483
Mailing Address - Fax:
Practice Address - Street 1:4930 SE 14TH ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50320-1604
Practice Address - Country:US
Practice Address - Phone:515-650-9483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS-092871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice