MEDICARE: DR. MARC FISHER 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	1223P0300X	Periodontics	7011	MD

General Provider Information

NPI Number	:	1861541484
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARC FISHER D.D.S.

Provider Business Mailing Address
First Line	:	306A CROSS GREEN ST
Second Line	:
City	:	GAITHERSBURG
State	:	MD
Zip	:	20878-5520
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13975 CONNECTICUT AVE STE 309
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20906-2921
Country	:	US
Telephone Number	:	301-871-7111
Fax Number	:

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

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	07/08/2007

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