1205917762 NPI number — DR. ROBERT FLETCHER, D.D.S., INC.

Table of content: (NPI 1205917762)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205917762 NPI number — DR. ROBERT FLETCHER, D.D.S., INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. ROBERT FLETCHER, D.D.S., INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
FLETCHER AND FLETCHER DENTISTRY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205917762
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/09/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
402 RED OAK ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUMMERSVILLE
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26651-1000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-692-9700
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
402 RED OAK ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUMMERSVILLE
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26651
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-872-5600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FLETCHER
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
ROWLAND
Authorized Official Title or Position:
CO-OWNER
Authorized Official Telephone Number:
304-872-5600

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X , with the licence number:  3639 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com