Jeffrey Paul Fish, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

D10663 Issued in MN

Practice address

107 W Main St
Crosby, MN 56441-1423

Phone

(218) 546-6031

Fax

(218) 546-8159

NPI assigned

Apr 24, 2006

Last updated

Aug 19, 2014By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1145836800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1408406400000",
    "number": "1962468470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 W MAIN ST",
            "city": "CROSBY",
            "state": "MN",
            "postal_code": "564411423",
            "telephone_number": "218-546-6031",
            "fax_number": "218-546-8159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 W MAIN ST",
            "city": "CROSBY",
            "state": "MN",
            "postal_code": "564411423",
            "telephone_number": "218-546-6031",
            "fax_number": "218-546-8159"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FISH",
        "first_name": "JEFFREY",
        "middle_name": "PAUL",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-24",
        "last_updated": "2014-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "D10663",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "226222300",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alisha Elsperger, MOTR/L
• Adam R English
• Heather Erickson, RD,LD,CDE
• Samuel T Feyder, PA-C
• Laura B Fier, MD
• Matthew Francis Fleming, PA-C
• Kenneth Gerard Fogal, MS VP
• Brittany M Fox, PHARMD, MPH, BCPS
• Kristin Lynn Furan-Kriesel, PSY.D, LP
• Kendra Lee Gacke, PHARMD

• Dentist in Crosby, MN
• Providers in Crosby, MN by specialty
• Dentist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.