Basic Information
| Provider Information | |||||||||
| NPI: | 1700910809 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FISHER | ||||||||
| FirstName: | ESTHER | ||||||||
| MiddleName: | M. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 4635 SOUTHWEST FWY | ||||||||
| Address2: | SUITE 700 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770277169 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7138770697 | ||||||||
| FaxNumber: | 7136238380 | ||||||||
| Practice Location | |||||||||
| Address1: | 12960 EAST FWY | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770155710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134533559 | ||||||||
| FaxNumber: | 7134535861 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223P0300X | 21114 | TX | Y | Dental Providers | Dentist | Periodontics |
ID Information
| ID | Type | State | Issuer | Description | 1529687-01 | 05 | TX | MEDICAID | 1529687-05 | 05 | TX | MEDICAID | 1529687-06 | 05 | TX | MEDICAID | 1529687-02 | 05 | TX | MEDICAID | 1529687-03 | 05 | TX | MEDICAID | 1529687-04 | 05 | TX | MEDICAID |