Provider Demographics
NPI:1932264512
Name:FISHER, JOSEPH ALEXANDER (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ALEXANDER
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:PO BOX 634
Mailing Address - Street 2:310 JACKSON AVE
Mailing Address - City:MOOREFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:26836
Mailing Address - Country:US
Mailing Address - Phone:304-530-6290
Mailing Address - Fax:304-530-6290
Practice Address - Street 1:310 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:MOOREFIELD
Practice Address - State:WV
Practice Address - Zip Code:26836
Practice Address - Country:US
Practice Address - Phone:304-530-6290
Practice Address - Fax:304-530-6290
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV23781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0135099000Medicaid