Provider Demographics
NPI:1518008762
Name:FISCH, GERALD W (DDS)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:W
Last Name:FISCH
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 1:675 WELLESLEY DR
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-3428
Mailing Address - Country:US
Mailing Address - Phone:909-626-9981
Mailing Address - Fax:
Practice Address - Street 1:14495 7TH ST STE A
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-4233
Practice Address - Country:US
Practice Address - Phone:760-245-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24546122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist