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General NPI Number Information
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NPI Number | 1740534361
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Entity Type | Organization
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Legal Business Name | ROSS H FISHMAN, DMD, MS, PA
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Dates
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Enumeration Date | 11/05/2012
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Last Update Date | 11/05/2012
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Provider Practice Location Address
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Address Line | 552 JACKSONVILLE DR
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City | JACKSONVILLE BEACH
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State | FL
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Zip | 32250-3813
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Country | US
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Telephone | 904-247-4097
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Fax | 904-247-8495
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Provider Business Mailing Address
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Address Line | 552 JACKSONVILLE DR
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City | JACKSONVILLE BEACH
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State | FL
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Zip | 32250-3813
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Country | US
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Telephone | 904-247-4097
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Fax | 904-247-8495
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROSS FISHMAN
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Credential | D.M.D.
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Telephone | 904-477-0282
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DN 16716
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License Number State | FL
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