Healthcare Provider Details

I. General information

NPI: 1255650974
Provider Name (Legal Business Name): DAVID FISCHER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2010
Last Update Date: 09/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3007 SPRING MILL DR
SPRINGFIELD IL
62704-6558
US

IV. Provider business mailing address

3007 SPRING MILL DR
SPRINGFIELD IL
62704-6558
US

V. Phone/Fax

Practice location:
  • Phone: 217-546-8100
  • Fax:
Mailing address:
  • Phone: 217-546-8100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019027800
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: