David Brogdon Fisher, DDS
Individual provider Active NPI Dentist · Klein, TX
NPI 1124366737 · NPPES record last updated Jan 17, 2013
Key facts
- NPI
- 1124366737
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 28618 (TX)
- Practice address
- 1310 Matson Manor CT
Klein, TX 77379-5608 - Phone
- (713) 725-5247
- NPI assigned
- Jan 17, 2013
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151104001846 | TX | Order and Referring Only - Oral Surgery |
1456661321 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28618 | TX | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 28618 | TX | Yes |
Addresses
Primary practice location
1310 Matson Manor CT
Klein, TX 77379-5608
Mailing address
1310 Matson Manor CT
Klein, TX 77379-5608
Phone (713) 725-5247
Other providers in Klein, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 17, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.