1710153713 NPI number — DEXTER K FLEMMING DDS MS PC

Table of content: (NPI 1710153713)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710153713 NPI number — DEXTER K FLEMMING DDS MS PC

Organization/Personal Information

Employer Identification Number (EIN):
N/A
Provider Organization Name:
DEXTER K FLEMMING DDS MS PC
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:
MICHIGAN CENTER FOR ORAL SURGERY
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:
1710153713
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22150 ALLEN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOODHAVEN
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48183-2271
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-675-1520
Provider Business Mailing Address Fax Number:
734-675-2118

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22150 ALLEN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOODHAVEN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48183-2271
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-675-1520
Provider Business Practice Location Address Fax Number:
734-675-2118
Provider Enumeration Date:
04/30/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FLEMMING
Authorized Official First Name:
DEXTER
Authorized Official Middle Name:
KERT
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
734-675-1520

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X , with the licence number:  2901017976 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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