Provider Demographics
NPI:1689836140
Name:FISHER, BOZHENA (DDS)
Entity Type:Individual
Prefix:DR
First Name:BOZHENA
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 1:2665 B TAPO CANYON RD.
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063
Mailing Address - Country:US
Mailing Address - Phone:818-636-1916
Mailing Address - Fax:805-526-6114
Practice Address - Street 1:2665 B TAPO CANYON RD.
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063
Practice Address - Country:US
Practice Address - Phone:818-636-1916
Practice Address - Fax:805-526-6114
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-26
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA598031223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry