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General NPI Number Information
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NPI Number | 1245890649
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Entity Type | Individual
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Provider Name | KAYLA MUXLOW FISHER DMD
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Gender | Female
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Dates
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Enumeration Date | 06/18/2019
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Last Update Date | 06/17/2024
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Provider Practice Location Address
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Address Line | 2186 W MAIN ST
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City | LOWELL
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State | MI
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Zip | 49331-8637
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Country | US
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Telephone | 616-897-8491
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Fax |
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Provider Business Mailing Address
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Address Line | 2186 W MAIN ST
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City | LOWELL
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State | MI
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Zip | 49331-8637
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Country | US
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Telephone | 810-404-1025
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 2901600196
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2901600196
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License Number State | MI
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