Healthcare Provider Details

I. General information

NPI: 1356367288
Provider Name (Legal Business Name): THOMAS E FISHER DDS MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 04/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3983 N POINTE DR
ZANESVILLE OH
43701-7361
US

IV. Provider business mailing address

PO BOX 8047
ZANESVILLE OH
43702-8047
US

V. Phone/Fax

Practice location:
  • Phone: 740-588-9000
  • Fax: 740-588-9889
Mailing address:
  • Phone: 740-588-9000
  • Fax: 740-588-9889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number35079106
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number30020613
License Number StateOH

VIII. Authorized Official

Name: THOMAS E FISHER
Title or Position: OWNER
Credential: DDS MD
Phone: 740-588-9000