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SOUTHERN DE ORAL AND MAXILLOFACIAL SURGERY ASSOCIATES PA NPI 1629144589


NPI Information

NPI: 1629144589
Provider Name: SOUTHERN DE ORAL AND MAXILLOFACIAL SURGERY ASSOCIATES, PA

Doing Business As: BRUCE D FISHER MD DMD

Classification: Dentist - 1223S0112X
Entity Type: Organization

Specialization: Oral and Maxillofacial Surgery

Address:
17605 NASSAU COMMONS BLVD STE C
LEWES, DE
ZIP 19958
Phone: (302) 644-2977
Get Directions

SOUTHERN DE ORAL AND MAXILLOFACIAL SURGERY ASSOCIATES, PA is an oral and maxillofacial surgery dentist in Lewes, DE. The provider is an oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. SOUTHERN DE ORAL AND MAXILLOFACIAL SURGERY ASSOCIATES, PA NPI is 1629144589. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Bruce D Fisher Md Dmd.

The provider's business location address is:

17605 NASSAU COMMONS BLVD STE C
LEWES, DE
ZIP 19958-284
Phone: (302) 644-2977
Fax: (302) 645-7561

The provider's authorized official is Bruce D Fisher .
The authorized official title is Owner and has the following contact phone number (302) 644-2977.

The enumeration date for this NPI number is 11/24/2006 and was last updated on 6/3/2022.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
11223S0112XDentistOral and Maxillofacial Surgery2000106563DELAWAREYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
11000015026MEDICAIDDELAWARE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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