Provider Demographics
NPI:1851466791
Name:FISCHER, FREDERIC RICHARD (DDS)
Entity Type:Individual
Prefix:
First Name:FREDERIC
Middle Name:RICHARD
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 1:2606 17TH ST
Mailing Address - Street 2:BOX M
Mailing Address - City:SPIRIT LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:51360
Mailing Address - Country:US
Mailing Address - Phone:712-336-3037
Mailing Address - Fax:712-336-3037
Practice Address - Street 1:2606 17TH ST
Practice Address - Street 2:
Practice Address - City:SPIRIT LAKE
Practice Address - State:IA
Practice Address - Zip Code:51360
Practice Address - Country:US
Practice Address - Phone:712-336-3037
Practice Address - Fax:712-336-3037
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2024-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA6108122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0148924Medicaid