Provider Demographics
NPI:1265457568
Name:J. DAVID FISHER, JR., DDS, PA
Entity Type:Organization
Organization Name:J. DAVID FISHER, JR., DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:J.
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-776-0741
Mailing Address - Street 1:1808 DOCTOR'S DR.
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330
Mailing Address - Country:US
Mailing Address - Phone:919-776-0741
Mailing Address - Fax:919-774-6443
Practice Address - Street 1:1808 DOCTOR'S DR.
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330
Practice Address - Country:US
Practice Address - Phone:919-776-0741
Practice Address - Fax:919-774-6443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC39941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8992718Medicaid
NC400044OtherUNITED CONCORDIA
NC92718OtherBCBS ID #
NC235997OtherTRIGON ID #
NC92718OtherBCBS ID #
NC2428794Medicare ID - Type Unspecified