Provider Demographics
NPI:1548364631
Name:FISCHER, TODD ALAN (DMD MS)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:ALAN
Last Name:FISCHER
Suffix:
Gender:M
Credentials:DMD MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 OFFICE PARK DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-3219
Mailing Address - Country:US
Mailing Address - Phone:910-353-5234
Mailing Address - Fax:
Practice Address - Street 1:17 OFFICE PARK DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-3219
Practice Address - Country:US
Practice Address - Phone:910-353-5234
Practice Address - Fax:910-353-1999
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC63381223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC92728OtherBLUE CROSS BLUE SHIELD NC
NC8992728Medicaid
NC2428603Medicare ID - Type Unspecified
NC92728OtherBLUE CROSS BLUE SHIELD NC