Provider Demographics
NPI:1447520655
Name:FISHER, TREAVOR (DDS)
Entity type:Individual
Prefix:DR
First Name:TREAVOR
Middle Name:
Last Name:FISHER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-1606
Mailing Address - Country:US
Mailing Address - Phone:541-269-2100
Mailing Address - Fax:541-267-7241
Practice Address - Street 1:328 S 2ND ST
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-1606
Practice Address - Country:US
Practice Address - Phone:541-269-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-04
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD93401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice