Provider Demographics
NPI:1841516176
Name:FISHER, DARELL ALAN (DDS)
Entity type:Individual
Prefix:
First Name:DARELL
Middle Name:ALAN
Last Name:FISHER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6255 OLD ROYALTON RD
Mailing Address - Street 2:
Mailing Address - City:BRECKSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44141-1857
Mailing Address - Country:US
Mailing Address - Phone:440-546-7266
Mailing Address - Fax:440-546-0888
Practice Address - Street 1:6255 OLD ROYALTON RD
Practice Address - Street 2:
Practice Address - City:BRECKSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44141-1857
Practice Address - Country:US
Practice Address - Phone:440-546-7266
Practice Address - Fax:440-546-0888
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-12
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30016173122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist