Provider Demographics
NPI:1669814190
Name:FISHER, KATRINA (DDS)
Entity Type:Individual
Prefix:DR
First Name:KATRINA
Middle Name:
Last Name:FISHER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 W BLUFF ST
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048-2417
Mailing Address - Country:US
Mailing Address - Phone:817-573-2652
Mailing Address - Fax:
Practice Address - Street 1:310 W BLUFF ST
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-2417
Practice Address - Country:US
Practice Address - Phone:817-573-2652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-25
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX374021223G0001X
IL0190295691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice