Provider Demographics
NPI:1164862181
Name:FLEWELLING, MICHAEL L (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:L
Last Name:FLEWELLING
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 1:741 BROADWAY ST UNIT 580
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120-7026
Mailing Address - Country:US
Mailing Address - Phone:269-683-4180
Mailing Address - Fax:
Practice Address - Street 1:24 N SAINT JOSEPH AVE
Practice Address - Street 2:SUITE E-2
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-2263
Practice Address - Country:US
Practice Address - Phone:269-683-4180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-05
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010208881223G0001X
IL019.0292021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice