Provider Demographics
NPI:1609084789
Name:FISHER, ROGER JOE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:JOE
Last Name:FISHER
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 1:5801 S. 58TH STREET
Mailing Address - Street 2:SUITE AA
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-6405
Mailing Address - Country:US
Mailing Address - Phone:402-488-2727
Mailing Address - Fax:402-488-4263
Practice Address - Street 1:5801 S 58TH STREET
Practice Address - Street 2:SUITE AA
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-6405
Practice Address - Country:US
Practice Address - Phone:402-488-2727
Practice Address - Fax:402-488-4263
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-20
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE55621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice