MEDICARE: DR. JOHN DAVID FISHER JR. D.D.S.

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	3994	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	235997	OTHER	NC	TRIGON IDENTIFICATION #
2	400044	OTHER	NC	UNITED CONCORDIA #
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	92718	OTHER	NC	BCBS OF NC PROVIDER #

General Provider Information

NPI Number	:	1295792174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN DAVID FISHER JR. D.D.S.

Provider Business Mailing Address
First Line	:	1808 DOCTORS DR
Second Line	:
City	:	SANFORD
State	:	NC
Zip	:	27330-5057
Country	:	US
Telephone Number	:	919-776-0741
Fax Number	:	919-774-6443

Provider Business Practice Location Address
First Line	:	1808 DOCTORS DR
Second Line	:
City	:	SANFORD
State	:	NC
Zip	:	27330-5057
Country	:	US
Telephone Number	:	919-776-0741
Fax Number	:	919-774-6443

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

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	07/08/2007

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