MEDICARE: DR. DAMEON A 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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	DN012060	GA

General Provider Information

NPI Number	:	1578645818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAMEON A FISHER DDS

Provider Business Mailing Address
First Line	:	1295 W SPRING ST SE
Second Line	:	210
City	:	SMYRNA
State	:	GA
Zip	:	30080-3667
Country	:	US
Telephone Number	:	770-319-8220
Fax Number	:	770-319-8650

Provider Business Practice Location Address
First Line	:	1295 W SPRING ST SE
Second Line	:	210
City	:	SMYRNA
State	:	GA
Zip	:	30080-3667
Country	:	US
Telephone Number	:	770-319-8220
Fax Number	:	770-319-8650

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

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	07/08/2007

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