Healthcare Provider Details

I. General information

NPI: 1477629293
Provider Name (Legal Business Name): GERHARD FISCHER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

464 E 141ST ST.
GLENPOOL OK
74033
US

IV. Provider business mailing address

PO BOX 797
GLENPOOL OK
74033-0797
US

V. Phone/Fax

Practice location:
  • Phone: 918-322-5553
  • Fax: 918-322-5556
Mailing address:
  • Phone: 918-322-5553
  • Fax: 918-322-5556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4464
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: