Provider Demographics
NPI:1174641740
Name:FISCHER, DAVID B (DDS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:B
Last Name:FISCHER
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 1:6785 MYERS LAKE AVE NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-7416
Mailing Address - Country:US
Mailing Address - Phone:616-874-6040
Mailing Address - Fax:616-874-2026
Practice Address - Street 1:6785 MYERS LAKE AVE NE
Practice Address - Street 2:SUITE A
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-7416
Practice Address - Country:US
Practice Address - Phone:616-874-6040
Practice Address - Fax:616-874-2026
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MID1440201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice