MEDICARE: DAVID B FISCHER DDS

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	D144020	MI

General Provider Information

NPI Number	:	1174641740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID B FISCHER DDS

Provider Business Mailing Address
First Line	:	6785 MYERS LAKE AVE NE
Second Line	:	SUITE A
City	:	ROCKFORD
State	:	MI
Zip	:	49341-7416
Country	:	US
Telephone Number	:	616-874-6040
Fax Number	:	616-874-2026

Provider Business Practice Location Address
First Line	:	6785 MYERS LAKE AVE NE
Second Line	:	SUITE A
City	:	ROCKFORD
State	:	MI
Zip	:	49341-7416
Country	:	US
Telephone Number	:	616-874-6040
Fax Number	:	616-874-2026

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

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	07/08/2007

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