Provider Demographics
NPI:1881777969
Name:FISCHER, KENNETH JOHN (DDS)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:JOHN
Last Name:FISCHER
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 1:7821 E PORTICO TER
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-6481
Mailing Address - Country:US
Mailing Address - Phone:714-904-7264
Mailing Address - Fax:714-633-4740
Practice Address - Street 1:1467 N WANDA RD STE 195
Practice Address - Street 2:
Practice Address - City:VILLA PARK
Practice Address - State:CA
Practice Address - Zip Code:92867-5344
Practice Address - Country:US
Practice Address - Phone:714-633-1200
Practice Address - Fax:714-633-4740
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA236031223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics