Active NPI
Mark Fisher DDS Professional Dental Corporation
- General Practice Dentistry
- Tarzana, CA
National Provider Identifier
1609086578
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- Legal business name
- MARK FISHER DDS PROFESSIONAL DENTAL CORPORATION
- Practice address
- 18411 Ventura Blvd
Tarzana, CA 91356-4201 - Phone
- (818) 345-2025
- Fax
- (818) 345-3229
- NPI assigned
- May 22, 2007
- Last updated
- Jul 10, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Mark Fisher, D.D.S.
- Title
- President
- Phone
- (818) 345-2025
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | Primary |
Addresses
Primary practice location
18411 Ventura Blvd
Tarzana, CA 91356-4201
Mailing address
18411 Ventura Blvd
Tarzana, CA 91356-4201
Phone (818) 345-2025
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| G9347801 | Medicaid | CA | |
| 244475 | Other | CA | DELTA DENTAL INSURANCE |
National Provider Directory
National Provider DirectoryLocations
18411 Ventura Blvd
Tarzana, CA 91356
Phone (818) 345-2025
Practitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- General Practice Dentistry
- Tarzana, CA
- NPI 1699973644
-
- General Practice Dentistry
- Tarzana, CA
- NPI 1225236276
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179792000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1184025600000",
"number": "1609086578",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18411 VENTURA BLVD",
"city": "TARZANA",
"state": "CA",
"postal_code": "913564201",
"telephone_number": "818-345-2025",
"fax_number": "818-345-3229"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18411 VENTURA BLVD",
"city": "TARZANA",
"state": "CA",
"postal_code": "913564201",
"telephone_number": "818-345-2025",
"fax_number": "818-345-3229"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MARK FISHER DDS PROFESSIONAL DENTAL CORPORATION",
"organizational_subpart": "NO",
"enumeration_date": "2007-05-22",
"last_updated": "2007-07-10",
"status": "A",
"authorized_official_last_name": "FISHER",
"authorized_official_first_name": "MARK",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "818-345-2025",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "D.D.S."
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dentist, General Practice",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "G9347801",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DELTA DENTAL INSURANCE",
"identifier": "244475",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tarzana, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.