Provider Demographics
NPI:1417936089
Name:FISHBEIN, GARY L (DMD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:L
Last Name:FISHBEIN
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:PO BOX 597
Mailing Address - Street 2:
Mailing Address - City:LILLIAN
Mailing Address - State:AL
Mailing Address - Zip Code:36549-0597
Mailing Address - Country:US
Mailing Address - Phone:251-961-3737
Mailing Address - Fax:251-961-3738
Practice Address - Street 1:12658 SANTA PIEDRO ST
Practice Address - Street 2:
Practice Address - City:LILLIAN
Practice Address - State:AL
Practice Address - Zip Code:36549-4042
Practice Address - Country:US
Practice Address - Phone:251-961-3737
Practice Address - Fax:251-961-3738
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL35851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice