Provider Demographics
NPI:1962650838
Name:FISHER, ANTHONY EDGAR (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:EDGAR
Last Name:FISHER
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 1:215 W HIGHLAND DR # D
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801-4114
Mailing Address - Country:US
Mailing Address - Phone:701-572-3414
Mailing Address - Fax:
Practice Address - Street 1:215 W HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-4114
Practice Address - Country:US
Practice Address - Phone:701-572-3414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-04
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND20161223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics