Provider Demographics
NPI:1659417335
Name:FISCHER, CARROL JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARROL
Middle Name:
Last Name:FISCHER
Suffix:JR
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 1:11326 HAYNE BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70128-1006
Mailing Address - Country:US
Mailing Address - Phone:504-245-8559
Mailing Address - Fax:504-245-8568
Practice Address - Street 1:11326 HAYNE BLVD
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70128-1006
Practice Address - Country:US
Practice Address - Phone:504-245-8559
Practice Address - Fax:504-245-8568
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA32801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice