Individual
DR. LARRY ALAN FISHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1945 W WILSON AVE, SUITE 2112, CHICAGO, IL 60640-5255
(773) 561-4508
(773) 561-4508
Mailing address
1945 W WILSON AVE, SUITE 2112, CHICAGO, IL 60640-5255
(773) 561-4508
(773) 561-4508
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019-015484
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
164971
—
IL
Enumeration date
10/31/2005
Last updated
08/28/2008
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