Healthcare Provider Details

I. General information

NPI: 1831024264
Provider Name (Legal Business Name): FISHER ORTHODONTICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2204 2ND AVE W
WILLISTON ND
58801-3485
US

IV. Provider business mailing address

2204 2ND AVE W
WILLISTON ND
58801-3485
US

V. Phone/Fax

Practice location:
  • Phone: 701-572-3414
  • Fax:
Mailing address:
  • Phone: 701-572-3414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: JANELLE CHARLES
Title or Position: OFFICE MANAGER
Credential:
Phone: 701-572-3414