Provider Demographics
NPI:1346385374
Name:FISHER, JIM MICHAEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:JIM
Middle Name:MICHAEL
Last Name:FISHER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1580 SOUTH MELROSE DRIVE
Mailing Address - Street 2:SUITE 112
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081-7469
Mailing Address - Country:US
Mailing Address - Phone:760-727-1089
Mailing Address - Fax:
Practice Address - Street 1:1580 SOUTH MELROSE DRIVE
Practice Address - Street 2:SUITE 112
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-7469
Practice Address - Country:US
Practice Address - Phone:760-727-1089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA307201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice