Provider Demographics
NPI:1356367288
Name:THOMAS E FISHER DDS MD INC
Entity type:Organization
Organization Name:THOMAS E FISHER DDS MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MD
Authorized Official - Phone:740-588-9000
Mailing Address - Street 1:PO BOX 8047
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43702-8047
Mailing Address - Country:US
Mailing Address - Phone:740-588-9000
Mailing Address - Fax:740-588-9889
Practice Address - Street 1:3983 N POINTE DR
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-7361
Practice Address - Country:US
Practice Address - Phone:740-588-9000
Practice Address - Fax:740-588-9889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35079106204E00000X
OH300206131223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9338211Medicare PIN