Healthcare Provider Details

I. General information

NPI: 1730185331
Provider Name (Legal Business Name): RICHARD BRIAN FISHER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 FEDERAL RD STE 215
BROOKFIELD CT
06804-2418
US

IV. Provider business mailing address

46 TURKEY HILL RD
NEWTOWN CT
06470-2397
US

V. Phone/Fax

Practice location:
  • Phone: 203-775-3300
  • Fax: 203-775-1302
Mailing address:
  • Phone: 203-775-3300
  • Fax: 203-775-1302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8278
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: