Provider Demographics
NPI:1023657343
Name:DANIEL J FISH DDS INC
Entity type:Organization
Organization Name:DANIEL J FISH DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:FISH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:479-409-5097
Mailing Address - Street 1:3257 N AUTUMN CT
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-6273
Mailing Address - Country:US
Mailing Address - Phone:479-409-5097
Mailing Address - Fax:
Practice Address - Street 1:2630 E CITIZENS DR STE 8
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4797
Practice Address - Country:US
Practice Address - Phone:479-409-5097
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-03
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty