Provider Demographics
NPI:1679610695
Name:FISHER, BRUCE DONALD (MD, DMD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:DONALD
Last Name:FISHER
Suffix:
Gender:M
Credentials:MD, DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17605 NASSAU COMMONS BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-6284
Mailing Address - Country:US
Mailing Address - Phone:302-644-2977
Mailing Address - Fax:302-645-7561
Practice Address - Street 1:17605 NASSAU COMMONS BLVD STE C
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-6284
Practice Address - Country:US
Practice Address - Phone:302-644-2977
Practice Address - Fax:302-645-7561
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEGI-00011211223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000014391Medicaid
DE147441Medicare UPIN
DEG01833S01Medicare ID - Type Unspecified