MEDICARE: DR. RICHARD PATRICK FISHER D.D.S., M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	3672-015	WI

General Provider Information

NPI Number	:	1316932338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD PATRICK FISHER D.D.S., M.S.

Provider Business Mailing Address
First Line	:	1600 CLEVELAND AVE
Second Line	:
City	:	MARINETTE
State	:	WI
Zip	:	54143-3923
Country	:	US
Telephone Number	:	715-735-7666
Fax Number	:	715-735-4383

Provider Business Practice Location Address
First Line	:	1600 CLEVELAND AVE
Second Line	:
City	:	MARINETTE
State	:	WI
Zip	:	54143-3923
Country	:	US
Telephone Number	:	715-735-7666
Fax Number	:	715-735-4383

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2005
Last Update Date	:	07/08/2007

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