Provider Demographics
NPI:1184796336
Name:FISHER, ERICA LYNN (DDS)
Entity type:Individual
Prefix:DR
First Name:ERICA
Middle Name:LYNN
Last Name:FISHER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5713 NW 64TH TER
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64151-2382
Mailing Address - Country:US
Mailing Address - Phone:816-505-9767
Mailing Address - Fax:816-505-1621
Practice Address - Street 1:5713 NW 64TH TER
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64151-2382
Practice Address - Country:US
Practice Address - Phone:816-505-9767
Practice Address - Fax:816-505-1621
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MODE0157361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice