Provider Demographics
NPI:1043279888
Name:FLEENER, MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:FLEENER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5345 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-2764
Mailing Address - Country:US
Mailing Address - Phone:563-359-1601
Mailing Address - Fax:359-355-7111
Practice Address - Street 1:5345 SPRING ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2764
Practice Address - Country:US
Practice Address - Phone:563-359-1601
Practice Address - Fax:359-355-7111
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA58401223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2155507Medicaid
IA0155507Medicaid
IA0155507Medicaid
IA15550Medicare ID - Type UnspecifiedDAVENPORT MEDICARE #
IA2155507Medicaid