Provider Demographics
NPI:1366413908
Name:FISHER, RICHARD LEE SR (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LEE
Last Name:FISHER
Suffix:SR
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 1:215 A MAIN STREET
Mailing Address - Street 2:PO BOX 446
Mailing Address - City:BROOKNEAL
Mailing Address - State:VA
Mailing Address - Zip Code:24528
Mailing Address - Country:US
Mailing Address - Phone:434-376-2238
Mailing Address - Fax:
Practice Address - Street 1:215 A MAIN STREET
Practice Address - Street 2:
Practice Address - City:BROOKNEAL
Practice Address - State:VA
Practice Address - Zip Code:24528
Practice Address - Country:US
Practice Address - Phone:434-376-2238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010023371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice