Healthcare Provider Details

I. General information

NPI: 1245316033
Provider Name (Legal Business Name): HOWARD BRAINUM FISHER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 VILLAGE SQUARE SUITE 130
BALTIMORE MD
21210
US

IV. Provider business mailing address

7 REGENCY CT
BALTIMORE MD
21208
US

V. Phone/Fax

Practice location:
  • Phone: 410-532-2200
  • Fax: 410-433-6395
Mailing address:
  • Phone: 410-484-4942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberMD6224
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: