=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730248527
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAREN EVELYN FISCHER DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/07/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6545 FRANCE AVE S SUITE 366
-----------------------------------------------------
City | EDINA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55435-2131
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 952-926-3858
-----------------------------------------------------
Fax | 952-926-9046
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18615 32ND AVE N
-----------------------------------------------------
City | PLYMOUTH
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55447-1030
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 763-449-9143
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | D11077
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------