Provider Demographics
NPI:1861520843
Name:FISHER, KRISTA S (DMD)
Entity type:Individual
Prefix:DR
First Name:KRISTA
Middle Name:S
Last Name:FISHER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:KRISTA
Other - Middle Name:S
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:180 OLD TAPPAN RD
Mailing Address - Street 2:BUILDING #6
Mailing Address - City:OLD TAPPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-7052
Mailing Address - Country:US
Mailing Address - Phone:201-768-5553
Mailing Address - Fax:201-768-7601
Practice Address - Street 1:180 OLD TAPPAN RD
Practice Address - Street 2:BUILDING #6
Practice Address - City:OLD TAPPAN
Practice Address - State:NJ
Practice Address - Zip Code:07675-7052
Practice Address - Country:US
Practice Address - Phone:201-768-5553
Practice Address - Fax:201-768-7601
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0158531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice