Provider Demographics
NPI:1669664397
Name:FISHER, JOHN PATRICK (DDS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:PATRICK
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 1:18 HAWTHORNE BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-3710
Mailing Address - Country:US
Mailing Address - Phone:978-744-1209
Mailing Address - Fax:978-744-1917
Practice Address - Street 1:18 HAWTHORNE BOULEVARD
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-3710
Practice Address - Country:US
Practice Address - Phone:978-744-1209
Practice Address - Fax:978-744-1917
Is Sole Proprietor?:No
Enumeration Date:2007-08-16
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA124931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice