Provider Demographics
NPI:1750313912
Name:FISHER, GREGORY R (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:R
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 1:1708 E. 44TH ST.
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98404
Mailing Address - Country:US
Mailing Address - Phone:253-572-7002
Mailing Address - Fax:253-593-2854
Practice Address - Street 1:1019 PACIFIC AVE.
Practice Address - Street 2:STE. 300
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402
Practice Address - Country:US
Practice Address - Phone:253-597-4550
Practice Address - Fax:253-597-4556
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA49231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice