Provider Demographics
NPI:1710266044
Name:FISHER, DANIEL JOHN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JOHN
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 1:2921 INVERNESS PL
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-5032
Mailing Address - Country:US
Mailing Address - Phone:619-980-8030
Mailing Address - Fax:
Practice Address - Street 1:MEDICAL STAFF SERVICES
Practice Address - Street 2:BLDG H 2005 KNIGHT LANE
Practice Address - City:FPO
Practice Address - State:AA
Practice Address - Zip Code:32212
Practice Address - Country:US
Practice Address - Phone:310-721-9229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-04
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0006700-C1223S0112X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program