Provider Demographics
NPI:1730282948
Name:FISHER, JEFFREY J (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:J
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:PO BOX 246
Mailing Address - Street 2:
Mailing Address - City:WHITELAND
Mailing Address - State:IN
Mailing Address - Zip Code:46184-0246
Mailing Address - Country:US
Mailing Address - Phone:317-535-5665
Mailing Address - Fax:317-535-5685
Practice Address - Street 1:119 N US HIGHWAY 31
Practice Address - Street 2:
Practice Address - City:WHITELAND
Practice Address - State:IN
Practice Address - Zip Code:46184-1459
Practice Address - Country:US
Practice Address - Phone:317-535-5665
Practice Address - Fax:317-535-5685
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12007856122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist