MEDICARE: DR. WAYNE E FISCHER D.D.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	122300000X	Dentist	11942	MO

General Provider Information

NPI Number	:	1760564520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WAYNE E FISCHER D.D.S.

Provider Business Mailing Address
First Line	:	3004 SUTTON BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63143-3016
Country	:	US
Telephone Number	:	314-645-0396
Fax Number	:	314-645-6163

Provider Business Practice Location Address
First Line	:	3004 SUTTON BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63143-3016
Country	:	US
Telephone Number	:	314-645-0396
Fax Number	:	314-645-6163

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

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	07/08/2007

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