Healthcare Provider Details

I. General information

NPI: 1467690990
Provider Name (Legal Business Name): FISHER DENTISTRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2009
Last Update Date: 01/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 SE SEDGWICK RD SUITE #3
PORT ORCHARD WA
98366-9502
US

IV. Provider business mailing address

PO BOX 818
PORT ORCHARD WA
98366-0818
US

V. Phone/Fax

Practice location:
  • Phone: 360-876-0445
  • Fax: 360-876-0447
Mailing address:
  • Phone: 360-876-0445
  • Fax: 360-876-0447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE 60041592
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number00006120
License Number StateWA

VIII. Authorized Official

Name: MRS. SANDRA LOREEN ARPS
Title or Position: BUSINESS ADMINISTRATOR
Credential:
Phone: 360-876-0445