Provider Demographics
NPI:1942399142
Name:FISHER, JANET S (DMD)
Entity Type:Individual
Prefix:DR
First Name:JANET
Middle Name:S
Last Name:FISHER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 MISSION 66
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39183-3137
Mailing Address - Country:US
Mailing Address - Phone:601-636-5321
Mailing Address - Fax:601-883-2366
Practice Address - Street 1:1212 MISSION 66
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39183-3137
Practice Address - Country:US
Practice Address - Phone:601-636-5321
Practice Address - Fax:601-883-2366
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS261491122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01325817Medicaid