Healthcare Provider Details

I. General information

NPI: 1073502266
Provider Name (Legal Business Name): BRIAN FISCHER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 BUSINESS LOOP 70 WEST SUITE 216C
COLUMBIA MO
65203
US

IV. Provider business mailing address

1001 W WORLEY ST FAMILY DENTAL CENTER
COLUMBIA MO
65203-2037
US

V. Phone/Fax

Practice location:
  • Phone: 573-214-2314
  • Fax: 573-442-5208
Mailing address:
  • Phone: 573-214-2314
  • Fax: 573-442-5208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2004014733
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: