Provider Demographics
NPI:1649490905
Name:ROBERT J. FISH, D.D.S.
Entity type:Organization
Organization Name:ROBERT J. FISH, D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:FISH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, JD
Authorized Official - Phone:954-720-7700
Mailing Address - Street 1:7737 N. UNIVERSITY DRIVE
Mailing Address - Street 2:100
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-2968
Mailing Address - Country:US
Mailing Address - Phone:954-720-7700
Mailing Address - Fax:954-724-4448
Practice Address - Street 1:7737 N. UNIVERSITY DRIVE
Practice Address - Street 2:100
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2968
Practice Address - Country:US
Practice Address - Phone:954-720-7700
Practice Address - Fax:954-724-4448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-27
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0005694122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty