MEDICARE: DR. CHARLES DANIEL FISHER DENTIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DS0000004867	TN

General Provider Information

NPI Number	:	1003961780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES DANIEL FISHER DENTIST

Provider Business Mailing Address
First Line	:	6215 RIVERVIEW CROSSING DR STE C
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37924-2839
Country	:	US
Telephone Number	:	865-546-7436
Fax Number	:	865-546-7259

Provider Business Practice Location Address
First Line	:	6215 RIVERVIEW CROSSING DR STE C
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37924-2839
Country	:	US
Telephone Number	:	865-546-7436
Fax Number	:	865-546-7259

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	04/15/2008

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