Provider Demographics
NPI:1255778247
Name:FISHER, LAURA A (DDS)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:A
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 1:2430 S I 35 E STE 210
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76205-4944
Mailing Address - Country:US
Mailing Address - Phone:940-202-0419
Mailing Address - Fax:940-228-0604
Practice Address - Street 1:2430 S INTERSTATE 35 E STE 210
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76205-4944
Practice Address - Country:US
Practice Address - Phone:940-202-0419
Practice Address - Fax:940-228-0604
Is Sole Proprietor?:No
Enumeration Date:2013-05-30
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT86683321223G0001X
TX379961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice