Healthcare Provider Details

I. General information

NPI: 1902302946
Provider Name (Legal Business Name): FISCHER FAMILY DENTISTRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2018
Last Update Date: 03/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2337 G ST STE 3
BELLEVILLE KS
66935-2463
US

IV. Provider business mailing address

2337 G ST STE 3
BELLEVILLE KS
66935-2463
US

V. Phone/Fax

Practice location:
  • Phone: 785-527-5602
  • Fax: 785-527-5979
Mailing address:
  • Phone: 785-527-5602
  • Fax: 785-527-5979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number6829
License Number StateKS

VIII. Authorized Official

Name: MARY KOLSKY
Title or Position: BKKP
Credential:
Phone: 785-527-5602