Provider Demographics
NPI:1568533230
Name:GUNNAR FISHER DENTISTRY
Entity Type:Organization
Organization Name:GUNNAR FISHER DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:GUNNAR
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-661-1199
Mailing Address - Street 1:20 E TIMONIUM RD STE 210
Mailing Address - Street 2:
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-3456
Mailing Address - Country:US
Mailing Address - Phone:410-308-4880
Mailing Address - Fax:
Practice Address - Street 1:20 E TIMONIUM RD STE 210
Practice Address - Street 2:
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-3456
Practice Address - Country:US
Practice Address - Phone:410-308-4880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD6230122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty