Provider Demographics
NPI:1174704258
Name:FISCHER, JESSICA MARIE
Entity type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:MARIE
Last Name:FISCHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37125 TENNESSEE SCHOOL DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OR
Mailing Address - Zip Code:97355-9638
Mailing Address - Country:US
Mailing Address - Phone:503-930-8821
Mailing Address - Fax:
Practice Address - Street 1:37125 TENNESSEE SCHOOL DR.
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OR
Practice Address - Zip Code:97355-9638
Practice Address - Country:US
Practice Address - Phone:503-930-8821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-17
Last Update Date:2007-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR118006126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant