Healthcare Provider Details

I. General information

NPI: 1962321950
Provider Name (Legal Business Name): FISHER DENTAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2691 TAPO CANYON RD STE C
SIMI VALLEY CA
93063-6845
US

IV. Provider business mailing address

2691 TAPO CANYON RD STE C
SIMI VALLEY CA
93063-6845
US

V. Phone/Fax

Practice location:
  • Phone: 805-526-6100
  • Fax:
Mailing address:
  • Phone: 805-526-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. YAN FISHER
Title or Position: CEO
Credential: DDS
Phone: 818-645-7594