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General NPI Number Information
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NPI Number | 1285624171
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Entity Type | Individual
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Provider Name | SHANE A FISHER DDS
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Gender | Male
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Dates
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Enumeration Date | 10/24/2005
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Last Update Date | 04/24/2025
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Provider Practice Location Address
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Address Line | 819 NE 26TH ST
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City | WILTON MANORS
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State | FL
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Zip | 33305-1239
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Country | US
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Telephone | 954-564-5540
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Fax |
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Provider Business Mailing Address
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Address Line | 2132 NW 5TH AVE
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City | WILTON MANORS
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State | FL
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Zip | 33311-3702
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Country | US
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Telephone | 773-577-7667
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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 | 019-025019
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 025-001997
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 5127015
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License Number State | WI
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Taxonomy #4
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DN29834
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License Number State | FL
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