Provider Demographics
NPI:1821484577
Name:FISCHER, DONALD JR
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:FISCHER
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 N NORTH DR
Mailing Address - Street 2:JAMESON ANNEX DENTAL
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57104-0915
Mailing Address - Country:US
Mailing Address - Phone:605-367-5161
Mailing Address - Fax:605-367-5166
Practice Address - Street 1:1600 N NORTH DR
Practice Address - Street 2:JAMESON ANNEX DENTAL
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57104-0915
Practice Address - Country:US
Practice Address - Phone:605-367-5161
Practice Address - Fax:605-367-5166
Is Sole Proprietor?:No
Enumeration Date:2015-04-09
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM669122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist