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Individual

DR. SHANE A FISHER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DDS

Contact information

Practice address
819 NE 26TH ST, WILTON MANORS, FL 33305-1239
(954) 564-5540
Mailing address
2132 NW 5TH AVE, WILTON MANORS, FL 33311-3702
(773) 577-7667

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
019-025019
IL
1223P0221X
Pediatric Dentistry
025-001997
IL
1223P0221X
Pediatric Dentistry
5127015
WI
1223P0221X
Pediatric Dentistry
Primary
DN29834
FL

Other

Enumeration date
10/24/2005
Last updated
04/24/2025
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