Provider Demographics
NPI:1356913115
Name:FISHER, ALEX (DMD)
Entity type:Individual
Prefix:DR
First Name:ALEX
Middle Name:
Last Name:FISHER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14190 RED ROCK CT
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95602-9395
Mailing Address - Country:US
Mailing Address - Phone:916-757-0655
Mailing Address - Fax:
Practice Address - Street 1:12344 FAIR OAKS BLVD STE A
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-2546
Practice Address - Country:US
Practice Address - Phone:916-236-4311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106397122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist