Provider Demographics
NPI:1720213788
Name:FESMIRE DENTAL PLLC
Entity Type:Organization
Organization Name:FESMIRE DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:FESMIRE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:601-919-2990
Mailing Address - Street 1:101 AVALON CT
Mailing Address - Street 2:SUITE C
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-7641
Mailing Address - Country:US
Mailing Address - Phone:601-919-2990
Mailing Address - Fax:601-919-2992
Practice Address - Street 1:101 AVALON CT
Practice Address - Street 2:SUITE C
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39047-7641
Practice Address - Country:US
Practice Address - Phone:601-919-2990
Practice Address - Fax:601-919-2992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-20
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty