Provider Demographics
NPI:1508869058
Name:FISHER, MARY M (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:M
Last Name:FISHER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6010 W MAPLE RD
Mailing Address - Street 2:STE 210
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-4406
Mailing Address - Country:US
Mailing Address - Phone:248-932-8980
Mailing Address - Fax:248-932-2281
Practice Address - Street 1:6010 W MAPLE RD
Practice Address - Street 2:STE 210
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-4406
Practice Address - Country:US
Practice Address - Phone:248-932-8980
Practice Address - Fax:248-419-6124
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-28
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI129901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice