1265986947 NPI number — DESIREE A. FLETCHER DDS

Table of content: (NPI 1265986947)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265986947 NPI number — DESIREE A. FLETCHER DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DESIREE A. FLETCHER DDS
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:
Provider Other Organization Name Type Code:
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:
1265986947
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/10/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12737 BEL RED RD
Provider Second Line Business Mailing Address:
#150
Provider Business Mailing Address City Name:
BELLEVUE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98005-2699
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-746-7410
Provider Business Mailing Address Fax Number:
425-641-3520

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12737 BEL RED RD
Provider Second Line Business Practice Location Address:
#150
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98005-2699
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-746-7410
Provider Business Practice Location Address Fax Number:
425-641-3520
Provider Enumeration Date:
08/10/2016

Additional Information

Authorized Official

Authorized Official Last Name:
FLETCHER
Authorized Official First Name:
DESIREE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER/DENTIST
Authorized Official Telephone Number:
425-746-7410

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  7649 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1922021781 . This is a "TYPE 2 NPI" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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