Healthcare Provider Details

I. General information

NPI: 1144911785
Provider Name (Legal Business Name): FISHER DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2023
Last Update Date: 05/16/2023
Certification Date: 05/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 5TH ST NE
ALICEVILLE AL
35442-2200
US

IV. Provider business mailing address

106 5TH ST NE
ALICEVILLE AL
35442-2200
US

V. Phone/Fax

Practice location:
  • Phone: 205-373-8726
  • Fax: 205-373-8724
Mailing address:
  • Phone: 205-373-8726
  • Fax: 205-373-8724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. LILLIE FISHER
Title or Position: OWNER/DENTIST
Credential: DMD
Phone: 256-714-1645