Provider Demographics
NPI:1205844099
Name:FLETES, LAURA GUADALUPE (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:GUADALUPE
Last Name:FLETES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2838 45TH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:HIGHLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46322-2905
Mailing Address - Country:US
Mailing Address - Phone:219-922-7945
Mailing Address - Fax:219-922-7946
Practice Address - Street 1:2838 45TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322-2905
Practice Address - Country:US
Practice Address - Phone:219-922-7945
Practice Address - Fax:219-922-7946
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120096191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice