Healthcare Provider Details

I. General information

NPI: 1659555720
Provider Name (Legal Business Name): JOHN MICHAEL FISH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/24/2007
Last Update Date: 12/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 US 70 HWY
HILDEBRAN NC
28637
US

IV. Provider business mailing address

PO BOX 665
HILDEBRAN NC
28637-0665
US

V. Phone/Fax

Practice location:
  • Phone: 828-397-5514
  • Fax: 828-397-3980
Mailing address:
  • Phone: 828-397-5514
  • Fax: 828-397-3980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5079
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: