MEDICARE: DR. DEVIN COURTNEY FISHER 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	DE 60041592	WA

General Provider Information

NPI Number	:	1346487873
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEVIN COURTNEY FISHER DDS

Provider Business Mailing Address
First Line	:	PO BOX 818
Second Line	:
City	:	PORT ORCHARD
State	:	WA
Zip	:	98366-0818
Country	:	US
Telephone Number	:	360-876-0445
Fax Number	:	360-876-0447

Provider Business Practice Location Address
First Line	:	2021 SE SEDGWICK RD
Second Line	:	SUITE #3
City	:	PORT ORCHARD
State	:	WA
Zip	:	98366-9502
Country	:	US
Telephone Number	:	360-876-0445
Fax Number	:	360-876-0447

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

Provider Enumeration Date	:	01/21/2009
Last Update Date	:	01/21/2009

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