Healthcare Provider Details

I. General information

NPI: 1972654531
Provider Name (Legal Business Name): BENJAMIN DANIEL FISHMAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 W GARFIELD AVE
CHARLEVOIX MI
49720-1631
US

IV. Provider business mailing address

895 MEADOW VIEW CT
CADILLAC MI
49601-2594
US

V. Phone/Fax

Practice location:
  • Phone: 231-547-6523
  • Fax: 231-547-6238
Mailing address:
  • Phone: 231-779-1860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901018872
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: