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General NPI Number Information
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NPI Number | 1891122776
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Entity Type | Organization
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Legal Business Name | BRADFORD B. FISHER DENTISTRY, PLLC
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Dates
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Enumeration Date | 10/09/2013
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Last Update Date | 10/09/2013
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Provider Practice Location Address
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Address Line | 207 7TH AVE S
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City | NAMPA
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State | ID
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Zip | 83651-3846
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Country | US
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Telephone | 208-442-0000
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Fax | 208-466-9853
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Provider Business Mailing Address
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Address Line | 207 7TH AVE S
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City | NAMPA
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State | ID
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Zip | 83651-3846
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Country | US
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Telephone | 208-442-0000
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Fax | 208-466-9853
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRADFORD B FISHER
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Credential | DDS
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Telephone | 208-442-0000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D1705
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License Number State | ID
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