Healthcare Provider Details

I. General information

NPI: 1346451036
Provider Name (Legal Business Name): FISHER AND MA DENTISTRY PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 09/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 HARDING PL
CHARLOTTE NC
28204-2825
US

IV. Provider business mailing address

1110 HARDING PL
CHARLOTTE NC
28204-2825
US

V. Phone/Fax

Practice location:
  • Phone: 704-333-1859
  • Fax: 704-332-6300
Mailing address:
  • Phone: 704-333-1859
  • Fax: 704-332-6300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberNC4765
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. ARNOLD M MA
Title or Position: OWNER/PARTNER
Credential: DDS
Phone: 704-333-1859