Provider Demographics
NPI:1487035077
Name:FISHEL, CALLIE MICHELE I (RDH, OM)
Entity Type:Individual
Prefix:
First Name:CALLIE
Middle Name:MICHELE
Last Name:FISHEL
Suffix:I
Gender:F
Credentials:RDH, OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 CREST RD
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37804-4305
Mailing Address - Country:US
Mailing Address - Phone:865-214-7772
Mailing Address - Fax:
Practice Address - Street 1:1850 CREST RD
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-4305
Practice Address - Country:US
Practice Address - Phone:865-214-7772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-09
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist