=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194861807
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARK E. FISCHER, D.M.D., P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/29/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 ROUTE 1 SUITE 1
-----------------------------------------------------
City | YARMOUTH
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04096-4711
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-846-7977
-----------------------------------------------------
Fax | 207-846-7976
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 500 ROUTE 1 SUITE 1
-----------------------------------------------------
City | YARMOUTH
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04096-4711
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-846-7977
-----------------------------------------------------
Fax | 207-846-7976
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MARK EDWARD FISCHER
-----------------------------------------------------
Credential | D.M.D.
-----------------------------------------------------
Telephone | 207-846-7977
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | 3602
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------