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General NPI Number Information
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NPI Number | 1023657343
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Entity Type | Organization
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Legal Business Name | DANIEL J FISH DDS INC
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Dates
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Enumeration Date | 01/03/2020
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Last Update Date | 01/03/2020
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Provider Practice Location Address
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Address Line | 2630 E CITIZENS DR STE 8
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-4797
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Country | US
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Telephone | 479-409-5097
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Fax |
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Provider Business Mailing Address
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Address Line | 3257 N AUTUMN CT
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-6273
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Country | US
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Telephone | 479-409-5097
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. DANIEL JOSEPH FISH
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Credential | DDS
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Telephone | 479-409-5097
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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