MEDICARE: REYNOLDS J. FISCHBACH II, D.D.S., P.A.

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	122300000X	Dentist	5017	MN

General Provider Information

NPI Number	:	1730248667
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REYNOLDS J. FISCHBACH II, D.D.S., P.A.

Provider Business Mailing Address
First Line	:	483 BRIMHALL ST
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55116-1508
Country	:	US
Telephone Number	:	651-698-0848
Fax Number	:	651-698-0091

Provider Business Practice Location Address
First Line	:	483 BRIMHALL ST
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55116-1508
Country	:	US
Telephone Number	:	651-698-0848
Fax Number	:	651-698-0091

Authorized Official
Title or Position	:	PRESIDENT
Name	:	REYNOLDS J FISCHBACH II
Credential	:	D.D.S.
Telephone Number	:	651-698-0848

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	08/22/2020

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