Provider Demographics
NPI:1891914032
Name:FISH, MICHAEL DUDI (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DUDI
Last Name:FISH
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 1:280 N CENTRAL AVE
Mailing Address - Street 2:SUITE 430
Mailing Address - City:HARTSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10530-1832
Mailing Address - Country:US
Mailing Address - Phone:914-421-1010
Mailing Address - Fax:914-421-1037
Practice Address - Street 1:280 N CENTRAL AVE
Practice Address - Street 2:SUITE 430
Practice Address - City:HARTSDALE
Practice Address - State:NY
Practice Address - Zip Code:10530-1832
Practice Address - Country:US
Practice Address - Phone:914-421-1010
Practice Address - Fax:914-421-1037
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051021122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist