Provider Demographics
NPI:1861005795
Name:FISHER, BOBBI FAYE (RDH)
Entity Type:Individual
Prefix:
First Name:BOBBI
Middle Name:FAYE
Last Name:FISHER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9324 LUCY JANE LN APT T05
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28270-2593
Mailing Address - Country:US
Mailing Address - Phone:704-962-2979
Mailing Address - Fax:
Practice Address - Street 1:135 S SHARON AMITY RD STE 204
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-3871
Practice Address - Country:US
Practice Address - Phone:704-365-2765
Practice Address - Fax:704-365-2767
Is Sole Proprietor?:No
Enumeration Date:2020-08-29
Last Update Date:2020-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5899124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist