Provider Demographics
NPI:1508116211
Name:FISHER, JOSEPH GUNNAR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:GUNNAR
Last Name:FISHER
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 1:20 E TIMONIUM RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-3400
Mailing Address - Country:US
Mailing Address - Phone:410-308-4880
Mailing Address - Fax:410-308-4883
Practice Address - Street 1:20 E TIMONIUM RD
Practice Address - Street 2:SUITE 210
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-3400
Practice Address - Country:US
Practice Address - Phone:410-308-4880
Practice Address - Fax:410-308-4883
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-11
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD62301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice