Provider Demographics
NPI:1023321924
Name:FISHER, MICHAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:FISHER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 GLENARM PL
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-5034
Mailing Address - Country:US
Mailing Address - Phone:303-534-2626
Mailing Address - Fax:303-892-7953
Practice Address - Street 1:1400 GLENARM PL
Practice Address - Street 2:200
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202-5034
Practice Address - Country:US
Practice Address - Phone:303-534-2626
Practice Address - Fax:303-892-7953
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-20
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6564122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist