1174639512 NPI number — DR. STANLEY LOUIS FLEMING DDS MS

Table of content: DR. STANLEY LOUIS FLEMING DDS MS (NPI 1174639512)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174639512 NPI number — DR. STANLEY LOUIS FLEMING DDS MS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FLEMING
Provider First Name:
STANLEY
Provider Middle Name:
LOUIS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS MS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FLEMING
Provider Other First Name:
STANLEY
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS PA
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1174639512
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
601 FAYETTEVILLE ST
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
DURHAM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-688-8949
Provider Business Mailing Address Fax Number:
919-688-6068

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 FAYETTEVILLE ST
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
DURHAM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-688-8949
Provider Business Practice Location Address Fax Number:
919-688-6068
Provider Enumeration Date:
08/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  3995 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 8992769 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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