Provider Demographics
NPI:1801389069
Name:FISHER, ALYSSA ELAINE (DDS)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:ELAINE
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 1:4109 LAHMEYER RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46815-5666
Mailing Address - Country:US
Mailing Address - Phone:260-235-2992
Mailing Address - Fax:260-486-0068
Practice Address - Street 1:4109 LAHMEYER RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46815-5666
Practice Address - Country:US
Practice Address - Phone:260-235-2992
Practice Address - Fax:260-486-0068
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-12
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012939A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice