| NPI | 1609948363 |
|---|---|
| Former Name | JACK COLEMAN FISHER |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TN 4275) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2012-03-15 |