Healthcare Provider Details

I. General information

NPI: 1164520177
Provider Name (Legal Business Name): ROSEMARIE FISCHBACH D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 03/25/2024
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR #3 KM 21 SUITE 2 MARGINAL LA DOLORES
RIO GRANDE PR
00745
US

IV. Provider business mailing address

PO BOX 2017
CEIBA PR
00735
US

V. Phone/Fax

Practice location:
  • Phone: 787-863-8440
  • Fax:
Mailing address:
  • Phone: 787-863-8440
  • Fax: 787-885-8497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number1722
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30973
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: