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General NPI Number Information
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NPI Number | 1831392810
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Entity Type | Organization
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Legal Business Name | GREGORY J FISHER DDS PA
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Dates
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Enumeration Date | 06/07/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 314 RIVERSIDE STREET
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City | PORTLAND
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State | ME
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Zip | 04103-1037
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Country | US
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Telephone | 207-774-2146
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Fax | 207-774-5069
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Provider Business Mailing Address
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Address Line | 314 RIVERSIDE STREET
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City | PORTLAND
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State | ME
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Zip | 04103-1037
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Country | US
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Telephone | 207-774-2146
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Fax | 207-774-5069
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GREGORY JOHN FISHER
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Credential | DDS
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Telephone | 207-774-2146
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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 | 2956
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License Number State | ME
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