Provider Demographics
NPI:1508940461
Name:FISHER, MARK N (DDS,MAGD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:N
Last Name:FISHER
Suffix:
Gender:F
Credentials:DDS,MAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9700 S DIXIE HWY
Mailing Address - Street 2:SUITE 910
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-2800
Mailing Address - Country:US
Mailing Address - Phone:305-670-9755
Mailing Address - Fax:305-670-9757
Practice Address - Street 1:9700 S DIXIE HWY
Practice Address - Street 2:SUITE 910
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-2800
Practice Address - Country:US
Practice Address - Phone:305-670-9755
Practice Address - Fax:305-670-9757
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL63561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice