Provider Demographics
NPI:1831286152
Name:FISHER, KIMEL PIERCE (DMD)
Entity Type:Individual
Prefix:DR
First Name:KIMEL
Middle Name:PIERCE
Last Name:FISHER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6784 VISTA GRANDE DR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-3500
Mailing Address - Country:US
Mailing Address - Phone:801-942-1040
Mailing Address - Fax:
Practice Address - Street 1:9844 S 1300 E STE 360
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-4698
Practice Address - Country:US
Practice Address - Phone:801-571-6999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT137058-9922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist