MEDICARE: DR. JAMES S FISHBEIN 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	1789	NH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	X04589FI	OTHER	MA BLUECROSS/BLUE SHIELD
2	020335040NH01	OTHER	ANTHEM BLUE CROSS/BLUE SH
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	059397	OTHER	UNITED CONCORDIA

General Provider Information

NPI Number	:	1922184373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES S FISHBEIN DDS

Provider Business Mailing Address
First Line	:	2456 LAFAYETTE RD
Second Line	:
City	:	PORTSMOUTH
State	:	NH
Zip	:	03801-5624
Country	:	US
Telephone Number	:	603-436-9908
Fax Number	:	603-436-1354

Provider Business Practice Location Address
First Line	:	2456 LAFAYETTE RD
Second Line	:
City	:	PORTSMOUTH
State	:	NH
Zip	:	03801-5624
Country	:	US
Telephone Number	:	603-436-9908
Fax Number	:	603-436-1354

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

Provider Enumeration Date	:	10/28/2006
Last Update Date	:	07/08/2007

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