Provider Demographics
NPI:1902977325
Name:FISHER, ROBERT LYNN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LYNN
Last Name:FISHER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:750 N CAPITOL AVE
Mailing Address - Street 2:C2
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95133-1942
Mailing Address - Country:US
Mailing Address - Phone:408-258-5244
Mailing Address - Fax:408-258-4768
Practice Address - Street 1:750 N CAPITOL AVE
Practice Address - Street 2:C2
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95133-1942
Practice Address - Country:US
Practice Address - Phone:408-258-5244
Practice Address - Fax:408-258-4768
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA217961223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA21796OtherST BD OF DENTAL EXAMINERS