Provider Demographics
NPI:1457957813
Name:DR. BROOKS K FISER, DDS PA
Entity Type:Organization
Organization Name:DR. BROOKS K FISER, DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BROOKS
Authorized Official - Middle Name:K
Authorized Official - Last Name:FISER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:479-459-3310
Mailing Address - Street 1:9000 ROGERS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-5249
Mailing Address - Country:US
Mailing Address - Phone:479-459-3310
Mailing Address - Fax:
Practice Address - Street 1:9000 ROGERS AVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-5249
Practice Address - Country:US
Practice Address - Phone:479-459-3310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental