Provider Demographics
NPI:1578645818
Name:FISHER, DAMEON A (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAMEON
Middle Name:A
Last Name:FISHER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:1295 W SPRING ST SE
Mailing Address - Street 2:210
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-3667
Mailing Address - Country:US
Mailing Address - Phone:770-319-8220
Mailing Address - Fax:770-319-8650
Practice Address - Street 1:1295 W SPRING ST SE
Practice Address - Street 2:210
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-3667
Practice Address - Country:US
Practice Address - Phone:770-319-8220
Practice Address - Fax:770-319-8650
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GADN0120601223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics