Provider Demographics
NPI:1821484064
Name:FISCHER, FREDERICK (DDS)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:
Last Name:FISCHER
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 76
Mailing Address - Street 2:
Mailing Address - City:HIGH RIDGE
Mailing Address - State:MO
Mailing Address - Zip Code:63049-0076
Mailing Address - Country:US
Mailing Address - Phone:636-677-5663
Mailing Address - Fax:
Practice Address - Street 1:2817 HIGH RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:HIGH RIDGE
Practice Address - State:MO
Practice Address - Zip Code:63049-2205
Practice Address - Country:US
Practice Address - Phone:636-677-5663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-14
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMO14148122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist