Healthcare Provider Details

I. General information

NPI: 1790907343
Provider Name (Legal Business Name): GARY FISHER, D.D.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1203 E 33RD ST SUITE 100
TULSA OK
74105-2040
US

IV. Provider business mailing address

1203 E 33RD ST STE 100
TULSA OK
74105-2013
US

V. Phone/Fax

Practice location:
  • Phone: 918-744-1555
  • Fax: 918-744-1545
Mailing address:
  • Phone: 918-744-1555
  • Fax: 918-744-1545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number4229
License Number StateOK

VIII. Authorized Official

Name: DR. GARY WALLACE FISHER
Title or Position: OWNER
Credential: D.D.S.
Phone: 918-744-1555