Provider Demographics
NPI:1952439895
Name:FISET, RICHARD E (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:E
Last Name:FISET
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 1:618 E 9TH ST
Mailing Address - Street 2:
Mailing Address - City:BIRDSBORO
Mailing Address - State:PA
Mailing Address - Zip Code:19508-2635
Mailing Address - Country:US
Mailing Address - Phone:610-582-3549
Mailing Address - Fax:
Practice Address - Street 1:508 E 1ST ST
Practice Address - Street 2:
Practice Address - City:BIRDSBORO
Practice Address - State:PA
Practice Address - Zip Code:19508-2339
Practice Address - Country:US
Practice Address - Phone:610-582-3541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS 025693-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADS-025693-LOtherDENTAL LICENSE