Provider Demographics
NPI:1740329416
Name:FISHER, MARK R (DMD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:R
Last Name:FISHER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11600 SE MILL PLAIN BLVD
Mailing Address - Street 2:SUITE J
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-5083
Mailing Address - Country:US
Mailing Address - Phone:360-892-1776
Mailing Address - Fax:360-892-8825
Practice Address - Street 1:11600 SE MILL PLAIN BLVD
Practice Address - Street 2:SUITE J
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-5083
Practice Address - Country:US
Practice Address - Phone:360-892-1776
Practice Address - Fax:360-892-8825
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000091261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice