Healthcare Provider Details

I. General information

NPI: 1508981309
Provider Name (Legal Business Name): MARK R FISS D.M.D., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 LIMESTONE RD
WILMINGTON DE
19808-1271
US

IV. Provider business mailing address

4901 LIMESTONE RD
WILMINGTON DE
19808-1271
US

V. Phone/Fax

Practice location:
  • Phone: 302-239-4600
  • Fax: 302-239-9951
Mailing address:
  • Phone: 302-239-4600
  • Fax: 302-239-9951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberG10001167
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: