Provider Demographics
NPI:1316199078
Name:FISCHER, DAVID VERGIL (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:VERGIL
Last Name:FISCHER
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 1:11576 S STATE ST STE 1203
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-7118
Mailing Address - Country:US
Mailing Address - Phone:801-619-8664
Mailing Address - Fax:801-619-8787
Practice Address - Street 1:11576 S STATE ST STE 1203
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-7118
Practice Address - Country:US
Practice Address - Phone:801-619-8664
Practice Address - Fax:801-619-8787
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-14
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT53233911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice