Provider Demographics
NPI:1619449048
Name:ALEXSANDR M FISHMAN DDS PA
Entity Type:Organization
Organization Name:ALEXSANDR M FISHMAN DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXSANDR
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-833-8380
Mailing Address - Street 1:11710 REISTERSTOWN RD STE 201
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-3363
Mailing Address - Country:US
Mailing Address - Phone:410-833-8380
Mailing Address - Fax:
Practice Address - Street 1:11710 REISTERSTOWN RD STE 201
Practice Address - Street 2:
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136-3363
Practice Address - Country:US
Practice Address - Phone:410-833-8380
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-24
Last Update Date:2018-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental