Provider Demographics
NPI:1013369701
Name:PLETCHER, AUSTIN JAMES (DMD)
Entity Type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:JAMES
Last Name:PLETCHER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 W DOUGLAS RD
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-1438
Mailing Address - Country:US
Mailing Address - Phone:574-277-2220
Mailing Address - Fax:
Practice Address - Street 1:605 W DOUGLAS RD
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-1438
Practice Address - Country:US
Practice Address - Phone:574-277-2220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-06
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012498A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist