Healthcare Provider Details

I. General information

NPI: 1538275037
Provider Name (Legal Business Name): FISHER DENTAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11634 W FLORISSANT AVENUE
ST LOUIS MO
63033
US

IV. Provider business mailing address

11634 W FLORISSANT AVENUE
ST LOUIS MO
63033
US

V. Phone/Fax

Practice location:
  • Phone: 314-837-9777
  • Fax: 314-837-9778
Mailing address:
  • Phone: 314-837-9777
  • Fax: 314-837-9778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number12781
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number State

VIII. Authorized Official

Name: MR. OLLIE CHRISTOPHER FISHER
Title or Position: PRESIDENT
Credential: DMD
Phone: 374-837-9777