Provider Demographics
NPI:1467690990
Name:FISHER DENTISTRY PLLC
Entity Type:Organization
Organization Name:FISHER DENTISTRY PLLC
Other - Org Name:FISHER DISTINCTIVE DENTISTRY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:BUSINESS ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:LOREEN
Authorized Official - Last Name:ARPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-876-0445
Mailing Address - Street 1:PO BOX 818
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-0818
Mailing Address - Country:US
Mailing Address - Phone:360-876-0445
Mailing Address - Fax:360-876-0447
Practice Address - Street 1:2021 SE SEDGWICK RD
Practice Address - Street 2:SUITE #3
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-9502
Practice Address - Country:US
Practice Address - Phone:360-876-0445
Practice Address - Fax:360-876-0447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-21
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 600415921223G0001X
WA000061201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA802581OtherUNITED CONCORDIA INS. CO.