Provider Demographics
NPI:1619298890
Name:FISCHER, DANIEL COLLEN (DDS)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:COLLEN
Last Name:FISCHER
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 1:32669 WARREN RD
Mailing Address - Street 2:SUITE #8
Mailing Address - City:GARDEN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48135-1677
Mailing Address - Country:US
Mailing Address - Phone:734-422-4350
Mailing Address - Fax:
Practice Address - Street 1:32669 WARREN RD
Practice Address - Street 2:SUITE #8
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-1677
Practice Address - Country:US
Practice Address - Phone:734-422-4350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-22
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901020224122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist