Healthcare Provider Details

I. General information

NPI: 1316932338
Provider Name (Legal Business Name): RICHARD PATRICK FISHER D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 CLEVELAND AVE
MARINETTE WI
54143-3923
US

IV. Provider business mailing address

1600 CLEVELAND AVE
MARINETTE WI
54143-3923
US

V. Phone/Fax

Practice location:
  • Phone: 715-735-7666
  • Fax: 715-735-4383
Mailing address:
  • Phone: 715-735-7666
  • Fax: 715-735-4383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number3672-015
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: