Provider Demographics
NPI:1295792174
Name:FISHER, JOHN DAVID JR (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DAVID
Last Name:FISHER
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1808 DOCTORS DR
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-5057
Mailing Address - Country:US
Mailing Address - Phone:919-776-0741
Mailing Address - Fax:919-774-6443
Practice Address - Street 1:1808 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-5057
Practice Address - Country:US
Practice Address - Phone:919-776-0741
Practice Address - Fax:919-774-6443
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC39941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC235997OtherTRIGON IDENTIFICATION #
NC400044OtherUNITED CONCORDIA #
NC8992718Medicaid
NC92718OtherBCBS OF NC PROVIDER #
NCU41428Medicare UPIN
NC2428794Medicare ID - Type Unspecified