Provider Demographics
NPI:1851313027
Name:FISHER, PHILIP RAY (DMD, PLLC)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:RAY
Last Name:FISHER
Suffix:
Gender:M
Credentials:DMD, PLLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 GLENDALE DR
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28786-4736
Mailing Address - Country:US
Mailing Address - Phone:828-452-3963
Mailing Address - Fax:
Practice Address - Street 1:103 HAYWOOD PARK DR
Practice Address - Street 2:
Practice Address - City:CLYDE
Practice Address - State:NC
Practice Address - Zip Code:28721-4405
Practice Address - Country:US
Practice Address - Phone:828-627-1050
Practice Address - Fax:828-627-1056
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC58071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0149121OtherBCBS
PA615188OtherUNITED CONCORDIA
AL810-20124OtherBCBS
NC92724OtherBCBS
MI7102NCOtherBCBS
NC8992724Medicaid
NC8992724Medicaid