Provider Demographics
NPI:1881688513
Name:FISHER, GARY WALLACE (DDS)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:WALLACE
Last Name:FISHER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1203 E 33RD ST
Mailing Address - Street 2:STE 100
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-2040
Mailing Address - Country:US
Mailing Address - Phone:918-744-1555
Mailing Address - Fax:918-744-1545
Practice Address - Street 1:1203 E 33RD ST
Practice Address - Street 2:STE 100
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-2040
Practice Address - Country:US
Practice Address - Phone:918-744-1555
Practice Address - Fax:918-744-1545
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK42291223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry