Provider Demographics
NPI:1184622276
Name:FISCHER, MARY E (DMD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:E
Last Name:FISCHER
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 1:7301 N ALTA AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97203-4807
Mailing Address - Country:US
Mailing Address - Phone:503-286-0023
Mailing Address - Fax:503-286-8335
Practice Address - Street 1:7301 N ALTA AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97203-4807
Practice Address - Country:US
Practice Address - Phone:503-286-0023
Practice Address - Fax:503-286-8335
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-12
Last Update Date:2007-07-08
Deactivation Date:2006-03-28
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
ORD6713122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist